Provider Demographics
NPI:1407169444
Name:HEASLEY, ALISSA MARIE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:MARIE
Last Name:HEASLEY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:ALISSA
Other - Middle Name:MARIE
Other - Last Name:BIRKENHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:6165 NW 86TH ST
Mailing Address - Street 2:#235
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2270
Mailing Address - Country:US
Mailing Address - Phone:515-490-1001
Mailing Address - Fax:515-238-2033
Practice Address - Street 1:3408 WOODLAND AVENUE
Practice Address - Street 2:SUITE 401
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6506
Practice Address - Country:US
Practice Address - Phone:515-490-1001
Practice Address - Fax:515-218-1502
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0074981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical