Provider Demographics
NPI:1881108926
Name:DAW, HEATHER NICHOLE
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:NICHOLE
Last Name:DAW
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:NICHOLE
Other - Last Name:ENGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 SW RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5500
Mailing Address - Country:US
Mailing Address - Phone:541-956-4943
Mailing Address - Fax:
Practice Address - Street 1:1175 E MAIN ST STE 1C
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7457
Practice Address - Country:US
Practice Address - Phone:541-772-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor