Provider Demographics
NPI:1942951074
Name:MAGLALANG, HEATHER GRACE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:GRACE
Last Name:MAGLALANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 W MCMILLAN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1236
Mailing Address - Country:US
Mailing Address - Phone:317-650-7683
Mailing Address - Fax:
Practice Address - Street 1:422 W LOVELAND AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2322
Practice Address - Country:US
Practice Address - Phone:513-334-7272
Practice Address - Fax:513-676-0051
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0472342Medicaid