Provider Demographics
NPI:1215405063
Name:WRIGHT, HEATHER LEA (MSW LGSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW LGSW
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 189
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-0189
Mailing Address - Country:US
Mailing Address - Phone:218-626-5175
Mailing Address - Fax:
Practice Address - Street 1:30 N 8TH ST
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1601
Practice Address - Country:US
Practice Address - Phone:218-626-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25617104100000X, 1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker