Provider Demographics
NPI:1780941062
Name:WISZCZUR-JOHNSON, HEATHER (LMSW, CAADC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WISZCZUR-JOHNSON
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WISZCZUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAADC
Mailing Address - Street 1:233 FULTON ST E STE 524
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3269
Mailing Address - Country:US
Mailing Address - Phone:616-335-0638
Mailing Address - Fax:844-697-2585
Practice Address - Street 1:233 FULTON ST E STE 524
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3269
Practice Address - Country:US
Practice Address - Phone:616-335-0638
Practice Address - Fax:844-697-2585
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00875101YA0400X
MI68010857131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)