Provider Demographics
NPI:1699359430
Name:PAUTZ, HEATHER MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:PAUTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:TOWER CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58071-0165
Mailing Address - Country:US
Mailing Address - Phone:701-840-9975
Mailing Address - Fax:
Practice Address - Street 1:1701 S 12TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6644
Practice Address - Country:US
Practice Address - Phone:701-751-0384
Practice Address - Fax:888-901-7234
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2643104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker