Provider Demographics
NPI:1619442597
Name:SOFO, HEATHER ELIZABETH (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:SOFO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-1503
Mailing Address - Country:US
Mailing Address - Phone:419-360-5531
Mailing Address - Fax:
Practice Address - Street 1:5800 MONROE ST STE A1
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2208
Practice Address - Country:US
Practice Address - Phone:419-360-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1500569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty