Provider Demographics
NPI:1477314573
Name:ADAMS, HEATHER ROSE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROSE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ROSE
Other - Last Name:DEAVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:917 W NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4105
Mailing Address - Country:US
Mailing Address - Phone:231-728-3501
Mailing Address - Fax:
Practice Address - Street 1:5757 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:231-728-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician