Provider Demographics
NPI:1013420082
Name:ELLIOTT-HECKAMAN, LAURA MEGAN (BA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MEGAN
Last Name:ELLIOTT-HECKAMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MEGAN
Other - Last Name:ELLOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:624 MARKET AVE N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1017
Mailing Address - Country:US
Mailing Address - Phone:330-493-4553
Mailing Address - Fax:330-493-9811
Practice Address - Street 1:624 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1017
Practice Address - Country:US
Practice Address - Phone:330-493-4553
Practice Address - Fax:330-493-9811
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator