Provider Demographics
NPI:1184111775
Name:SIBLEY, HEATHER (LSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SIBLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29957 ELGIN RD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1729
Mailing Address - Country:US
Mailing Address - Phone:440-520-2518
Mailing Address - Fax:
Practice Address - Street 1:8532 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5822
Practice Address - Country:US
Practice Address - Phone:440-205-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH116895301104100000X
OHI.24056491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker