Provider Demographics
NPI:1497927636
Name:HEIKKENEN, LAURIE LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:LYNN
Last Name:HEIKKENEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E BIRCH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3054
Mailing Address - Country:US
Mailing Address - Phone:509-527-8451
Mailing Address - Fax:509-527-0942
Practice Address - Street 1:120 E BIRCH ST STE 9
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3054
Practice Address - Country:US
Practice Address - Phone:509-527-8451
Practice Address - Fax:509-527-0942
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000085201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8859583Medicare PIN