Provider Demographics
NPI:1851816649
Name:DONNENWIRTH, HEATHER (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DONNENWIRTH
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:972 STATE ROUTE 545
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9710
Mailing Address - Country:US
Mailing Address - Phone:419-685-5332
Mailing Address - Fax:844-946-0882
Practice Address - Street 1:12 W MAIN ST STE 135
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-2218
Practice Address - Country:US
Practice Address - Phone:419-685-5332
Practice Address - Fax:844-946-0882
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19016741041C0700X
OH5.15023541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1073952271Medicaid