Provider Demographics
NPI:1669655239
Name:HEATHERMAN, ASHLEY KAY (MSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KAY
Last Name:HEATHERMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:KAY
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3607 S FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3622
Mailing Address - Country:US
Mailing Address - Phone:918-955-0335
Mailing Address - Fax:
Practice Address - Street 1:5200 S YALE AVE STE 203
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7486
Practice Address - Country:US
Practice Address - Phone:918-955-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0147011041C0700X
OK76681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical