Provider Demographics
NPI:1356775282
Name:HEIN, CAROL ADELLE (BED)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ADELLE
Last Name:HEIN
Suffix:
Gender:F
Credentials:BED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 LIBERTY RD. SE #102
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:541-359-6832
Mailing Address - Fax:
Practice Address - Street 1:3345 LIBERTY RD S APT 102
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4889
Practice Address - Country:US
Practice Address - Phone:541-359-6832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker