Stephanie Heitman
Organization Active NPI Clinical Social Worker · Perry, IA
NPI 1194463414 · NPPES record last updated May 16, 2023
Key facts
- NPI
- 1194463414
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- STEPHANIE HEITMAN
- Practice address
- 602 Otley Ave
Perry, IA 50220-1088 - Phone
- (515) 992-6638
- NPI assigned
- May 25, 2022
- Organization subpart
- No
Authorized official
- Name
- Stephanie Heitman, LISW
- Title
- Owner
- Phone
- (515) 992-6638
Practitioners 3
-
Megan Reed, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230609000892 | IA | Part B Supplier - Clinic/Group Practice | 2668839432 |
Receives reassigned benefits from 2 practitioners Practice locations: Perry, IA |
National Provider Directory
Locations
1220 Willis Ave
Ste 12
Perry, IA 50220
Phone (515) 992-6638
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
602 Otley Ave
Perry, IA 50220-1088
Mailing address
PO Box 253
Perry, IA 50220-0253
Phone (515) 992-6638
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006958 | Medicaid | IA | |
| 107903 | Medicaid | IA | |
| 2218121 | Medicaid | IA |
Other names
- Counseling for Psychological Resilience
- Heitman Mental Health Services
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | seheitman@mchsi.com | ||
| Direct Messaging Address | seheitman@mchsi.com |
Other providers in Perry, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.