Provider Demographics
NPI:1629533864
Name:COUGHLIN, HEATHER MARIE (LISW-S)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:MILANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5653 GOODELL RD
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-9744
Mailing Address - Country:US
Mailing Address - Phone:330-842-2997
Mailing Address - Fax:
Practice Address - Street 1:2279 ROMIG RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3823
Practice Address - Country:US
Practice Address - Phone:330-253-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.16007381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical