Provider Demographics
NPI:1215034269
Name:HECKERMAN, LEE ELLEN (LSCSW)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ELLEN
Last Name:HECKERMAN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:ELLEN
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6700 W CENTRAL AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6302
Mailing Address - Country:US
Mailing Address - Phone:316-945-5200
Mailing Address - Fax:316-945-5549
Practice Address - Street 1:6700 W CENTRAL AVE
Practice Address - Street 2:STE 106
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6302
Practice Address - Country:US
Practice Address - Phone:316-683-4083
Practice Address - Fax:316-689-8431
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1953101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200740390CMedicaid