Provider Demographics
NPI:1508350364
Name:GOERZEN, HEIDI JO (LSCSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:GOERZEN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-8938
Mailing Address - Country:US
Mailing Address - Phone:620-869-9986
Mailing Address - Fax:
Practice Address - Street 1:114 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-8938
Practice Address - Country:US
Practice Address - Phone:620-869-9986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS057591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical