Provider Demographics
NPI:1518396449
Name:DERRICK, HEATHER A (LLBSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:DERRICK
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3638
Mailing Address - Country:US
Mailing Address - Phone:616-455-0960
Mailing Address - Fax:616-455-7324
Practice Address - Street 1:4255 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3638
Practice Address - Country:US
Practice Address - Phone:616-455-0960
Practice Address - Fax:616-455-7324
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator