Provider Demographics
NPI:1689838914
Name:RAZNICK, HEATHER K (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:RAZNICK
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SOUTH NEW BALLAS RD
Mailing Address - Street 2:TOWER A, SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-993-8255
Mailing Address - Fax:314-993-6080
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 300 TOWER A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-993-8255
Practice Address - Fax:314-993-6080
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0049621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical