Provider Demographics
NPI:1770082935
Name:EVERETT, HEATHER RENEE (LISW-S)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 MINNEWAUKAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2405
Mailing Address - Country:US
Mailing Address - Phone:513-708-6833
Mailing Address - Fax:
Practice Address - Street 1:10945 REED HARTMAN HWY STE 203
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2853
Practice Address - Country:US
Practice Address - Phone:513-708-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1.11000381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical