Provider Demographics
NPI:1578519294
Name:HEISHMAN-DONAHUE, KIMBERLY A (MA, LSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HEISHMAN-DONAHUE
Suffix:
Gender:F
Credentials:MA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 DEERFIELD AVE NW
Mailing Address - Street 2:
Mailing Address - City:N LAWRENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44666-9501
Mailing Address - Country:US
Mailing Address - Phone:330-682-7318
Mailing Address - Fax:
Practice Address - Street 1:85 COMMUNITY RD
Practice Address - Street 2:SUITE F
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2356
Practice Address - Country:US
Practice Address - Phone:330-633-1206
Practice Address - Fax:330-633-1364
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0010990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health