Provider Demographics
NPI:1609136696
Name:WEEKLY, HEATHER L (LSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:WEEKLY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2363
Mailing Address - Country:US
Mailing Address - Phone:740-264-7751
Mailing Address - Fax:740-264-2422
Practice Address - Street 1:220 MURDOCK ST
Practice Address - Street 2:
Practice Address - City:MINGO JUNCTION
Practice Address - State:OH
Practice Address - Zip Code:43938-1062
Practice Address - Country:US
Practice Address - Phone:740-535-1314
Practice Address - Fax:740-535-1290
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200517Medicaid
OH0200517Medicaid