Provider Demographics
NPI:1639502735
Name:STUMPF, HEATHER ANN (LISW-S)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:STUMPF
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 REGAL PL
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2525
Mailing Address - Country:US
Mailing Address - Phone:614-556-0074
Mailing Address - Fax:
Practice Address - Street 1:929 HARRISON AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1346
Practice Address - Country:US
Practice Address - Phone:614-940-4868
Practice Address - Fax:614-923-7525
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0028241-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical