Provider Demographics
NPI:1346692084
Name:GOEHMANN, HEIDI L (LIMHP, LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:GOEHMANN
Suffix:
Gender:F
Credentials:LIMHP, LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7346 GOLFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-9381
Mailing Address - Country:US
Mailing Address - Phone:314-420-2591
Mailing Address - Fax:
Practice Address - Street 1:5705 W JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1516
Practice Address - Country:US
Practice Address - Phone:231-425-4414
Practice Address - Fax:231-425-4434
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1894101YM0800X
NE17411041C0700X
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026827800Medicaid