Provider Demographics
NPI:1164067716
Name:GIESE, HEATHER LYN (LMSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYN
Last Name:GIESE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-0090
Mailing Address - Country:US
Mailing Address - Phone:231-245-9730
Mailing Address - Fax:
Practice Address - Street 1:130 W WOOD ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8991
Practice Address - Country:US
Practice Address - Phone:231-942-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010861371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical