Provider Demographics
NPI:1457593345
Name:MONTROSS, HEATHER JO (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JO
Last Name:MONTROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5511
Mailing Address - Country:US
Mailing Address - Phone:307-633-3044
Mailing Address - Fax:307-633-7256
Practice Address - Street 1:2600 E. 18TH STREET
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5511
Practice Address - Country:US
Practice Address - Phone:307-633-3044
Practice Address - Fax:307-633-7256
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLCSW 704OtherLICENSE
WY1457593345Medicaid
WYW24075Medicare PIN