Provider Demographics
NPI:1285866251
Name:KOONTZ, HEATHER (MSW, LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2710
Mailing Address - Country:US
Mailing Address - Phone:419-228-2070
Mailing Address - Fax:
Practice Address - Street 1:1130 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2710
Practice Address - Country:US
Practice Address - Phone:419-228-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0024858 SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical