Provider Demographics
NPI:1164828380
Name:KALSO, HEATHER (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:KALSO
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 1:3599 S DEWITT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-9206
Mailing Address - Country:US
Mailing Address - Phone:989-245-4732
Mailing Address - Fax:
Practice Address - Street 1:5000 NORTHWIND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5044
Practice Address - Country:US
Practice Address - Phone:517-853-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-16
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010944671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical