Provider Demographics
NPI:1710513213
Name:HEGGEN, KATHRYN A (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:HEGGEN
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 1:3203 TIMPSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-9556
Mailing Address - Country:US
Mailing Address - Phone:616-690-0646
Mailing Address - Fax:
Practice Address - Street 1:3203 TIMPSON AVE SE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9556
Practice Address - Country:US
Practice Address - Phone:616-690-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical