Provider Demographics
NPI:1235482365
Name:HEITZ, MARCIA ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:ANNE
Last Name:HEITZ
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 1:9706 E. SINNETT CHAPEL RD.
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:IL
Mailing Address - Zip Code:61427
Mailing Address - Country:US
Mailing Address - Phone:309-338-3687
Mailing Address - Fax:
Practice Address - Street 1:9706 E SINNETT CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:IL
Practice Address - Zip Code:61427-9469
Practice Address - Country:US
Practice Address - Phone:309-338-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490099681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical