Provider Demographics
NPI:1184974727
Name:CALLAHAN, HEIDI (PCW II)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PCW II
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCW II
Mailing Address - Street 1:3650 S POINTE CIR STE 208
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-0423
Mailing Address - Country:US
Mailing Address - Phone:702-298-5313
Mailing Address - Fax:702-298-0188
Practice Address - Street 1:3650 S POINTE CIR STE 208
Practice Address - Street 2:
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-0423
Practice Address - Country:US
Practice Address - Phone:702-298-5313
Practice Address - Fax:702-298-0188
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator