Provider Demographics
NPI:1861813966
Name:HEARTWELL, DAWN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:HEARTWELL
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 1:1733 WHITMORE AVE NW
Mailing Address - Street 2:WHITMORE AVE
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-2350
Mailing Address - Country:US
Mailing Address - Phone:616-914-4502
Mailing Address - Fax:
Practice Address - Street 1:1331 FRANKLIN ST SE
Practice Address - Street 2:WHITMORE AVE
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2634
Practice Address - Country:US
Practice Address - Phone:616-914-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010891491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical