Provider Demographics
NPI:1467904151
Name:BENNETT-HEINZ, MELISSA LYNN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYNN
Last Name:BENNETT-HEINZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 W. BOONE
Mailing Address - Street 2:SUITE 656
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201
Mailing Address - Country:US
Mailing Address - Phone:509-242-7274
Mailing Address - Fax:
Practice Address - Street 1:316 W. BOONE
Practice Address - Street 2:SUITE 656
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-242-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW606897011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical