Provider Demographics
NPI:1972946929
Name:RODRIGUEZ, HEIDI K (LCSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:K
Last Name:RODRIGUEZ
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 1:90 E 300 S
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1829
Mailing Address - Country:US
Mailing Address - Phone:435-469-2453
Mailing Address - Fax:
Practice Address - Street 1:152 N 400 W
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-5549
Practice Address - Country:US
Practice Address - Phone:435-283-8400
Practice Address - Fax:435-283-8401
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT27091135011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical