Provider Demographics
NPI:1306827407
Name:HEFFNER, DORIS S (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:S
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:DORIS
Other - Middle Name:EILEEN
Other - Last Name:SRAMEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:516 FULLER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3301
Mailing Address - Country:US
Mailing Address - Phone:406-449-4800
Mailing Address - Fax:406-449-1393
Practice Address - Street 1:34 W 6TH AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5074
Practice Address - Country:US
Practice Address - Phone:406-449-4800
Practice Address - Fax:406-449-1393
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT501150Medicaid