Provider Demographics
NPI:1801508189
Name:HEIDKAMP, DANA KATHERINE (LMSW)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:KATHERINE
Last Name:HEIDKAMP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 CONVICT HILL RD APT 1010
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2231
Mailing Address - Country:US
Mailing Address - Phone:512-484-5289
Mailing Address - Fax:
Practice Address - Street 1:7719 WOOD HOLLOW DR STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1634
Practice Address - Country:US
Practice Address - Phone:512-610-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67735104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker