Provider Demographics
NPI:1831457035
Name:SCANLAN, HEIDI JEAN WARREN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:JEAN WARREN
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JEAN
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2631 MARYLHURST DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1357
Mailing Address - Country:US
Mailing Address - Phone:503-855-9043
Mailing Address - Fax:
Practice Address - Street 1:2631 MARYLHURST DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1357
Practice Address - Country:US
Practice Address - Phone:503-855-9043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC602795481041C0700X
ORL78361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical