Provider Demographics
NPI:1245355940
Name:HESTON, KLARE (LISW)
Entity type:Individual
Prefix:
First Name:KLARE
Middle Name:
Last Name:HESTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KLARE
Other - Middle Name:
Other - Last Name:ACS-BRAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:8481 BANK ST
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-9432
Mailing Address - Country:US
Mailing Address - Phone:440-319-0446
Mailing Address - Fax:
Practice Address - Street 1:16600 W SPRAGUE RD STE 90
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-6318
Practice Address - Country:US
Practice Address - Phone:440-941-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00093641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical