Provider Demographics
NPI:1558462796
Name:HEASLIP, CLAYRE B (LCSW)
Entity Type:Individual
Prefix:
First Name:CLAYRE
Middle Name:B
Last Name:HEASLIP
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 1:2232 42ND AVE SE UNIT 318
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-6585
Mailing Address - Country:US
Mailing Address - Phone:503-375-0020
Mailing Address - Fax:
Practice Address - Street 1:2232 42ND AVE SE UNIT 318
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-6585
Practice Address - Country:US
Practice Address - Phone:503-375-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00246500Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ORR131473Medicare ID - Type Unspecified