Provider Demographics
NPI:1245730506
Name:HEIDRICH, MEGAN (LMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HEIDRICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 SILVER RAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5034
Mailing Address - Country:US
Mailing Address - Phone:785-331-8737
Mailing Address - Fax:
Practice Address - Street 1:838 SILVER RAIN RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5034
Practice Address - Country:US
Practice Address - Phone:785-331-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9326104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty