Provider Demographics
NPI:1811420102
Name:HEISLER, KATHERINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:HEISLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 INLAND EMPIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5577
Mailing Address - Country:US
Mailing Address - Phone:909-378-6070
Mailing Address - Fax:909-259-2457
Practice Address - Street 1:3400 INLAND EMPIRE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5577
Practice Address - Country:US
Practice Address - Phone:909-378-6070
Practice Address - Fax:909-259-2457
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW759011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical