Provider Demographics
NPI:1174640320
Name:HEITER, MONICA JO (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:JO
Last Name:HEITER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S BUSINESS HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1515
Mailing Address - Country:US
Mailing Address - Phone:660-259-2440
Mailing Address - Fax:660-251-0524
Practice Address - Street 1:206 N BISMARK ST STE A
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020
Practice Address - Country:US
Practice Address - Phone:660-463-0234
Practice Address - Fax:660-463-0266
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060082251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical