Provider Demographics
NPI:1467995035
Name:BLEEKE, HEATHER SUE (MA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUE
Last Name:BLEEKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:SUE
Other - Last Name:JOHNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CRC, CCM
Mailing Address - Street 1:830 IVY CREEK CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-3581
Mailing Address - Country:US
Mailing Address - Phone:260-432-4489
Mailing Address - Fax:
Practice Address - Street 1:830 IVY CREEK CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-3581
Practice Address - Country:US
Practice Address - Phone:260-432-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor