Provider Demographics
NPI:1265106926
Name:WARDLAW, HEATHER LYNN (LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:WARDLAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7914 WALTHAM RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1713
Mailing Address - Country:US
Mailing Address - Phone:267-419-7846
Mailing Address - Fax:
Practice Address - Street 1:201 YORK RD STE 1-564
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3200
Practice Address - Country:US
Practice Address - Phone:267-419-7846
Practice Address - Fax:215-372-0124
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional