Provider Demographics
NPI:1497986210
Name:HEIZER, KIM (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:HEIZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8477 MARY CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8999
Mailing Address - Country:US
Mailing Address - Phone:317-258-7652
Mailing Address - Fax:
Practice Address - Street 1:900 E 56TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7604
Practice Address - Country:US
Practice Address - Phone:317-258-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003494A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical