Provider Demographics
NPI:1376585653
Name:LAMPTON, HEATHER R (HSPP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:LAMPTON
Suffix:
Gender:F
Credentials:HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 OLD CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-4324
Mailing Address - Country:US
Mailing Address - Phone:574-232-8808
Mailing Address - Fax:574-232-9270
Practice Address - Street 1:4650 OLD CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-4324
Practice Address - Country:US
Practice Address - Phone:574-232-8808
Practice Address - Fax:574-232-9270
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041895A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical