Provider Demographics
NPI:1740303346
Name:HEISE, KATHY R (RN,COHN,CCM)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:R
Last Name:HEISE
Suffix:
Gender:F
Credentials:RN,COHN,CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 COUNTY ROAD 80
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:OH
Mailing Address - Zip Code:45812-9637
Mailing Address - Country:US
Mailing Address - Phone:419-366-1336
Mailing Address - Fax:419-757-7485
Practice Address - Street 1:3878 COUNTY ROAD 80
Practice Address - Street 2:
Practice Address - City:ALGER
Practice Address - State:OH
Practice Address - Zip Code:45812-9637
Practice Address - Country:US
Practice Address - Phone:419-366-1336
Practice Address - Fax:419-757-7485
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN274598171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator