Heather Marie Russom-Earls, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2020012392 Issued in MO

Practice address

935 State Route VV
Kennett, MO 63857-3822

Phone

(573) 888-5925

NPI assigned

Mar 29, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Heather Marie Eddy Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Maria Francisco, LCSW, LLC

  • Clinical Social Worker
  • Poplar Bluff, MO
  • NPI 1396232807
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1447755418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 STATE ROUTE VV",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573822",
            "telephone_number": "573-888-5925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 STATE ROUTE VV",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573822",
            "telephone_number": "573-888-5925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1891 Sunset Dr",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639012805",
            "country_code": "US",
            "telephone_number": "573-778-9185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSOM-EARLS",
        "first_name": "HEATHER",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-29",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2020012392",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2018010403",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "EDDY",
            "middle_name": "MARIE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brandon Douglas Rouse, OD
• Marilyn Faye Rouse
• Zachary Shea Rousell
• Wilbert James Rowell
• Courtney Elyse Rushing
• Courtney Lynn Rutherford
• Jason B Ryan, PLPC
• Casey Samples
• Jennifer Dee Sanchez
• Kristy Sanders, LPN

• Clinical Social Worker in Kennett, MO
• Providers in Kennett, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.