Heather Hazelwood Dausman, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3504 Issued in KY

Practice address

1215 High St
Bowling Green, KY 42101-2541

Phone

(270) 782-1116

Fax

(270) 782-9108

NPI assigned

Jun 2, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Chestnut Park Professionals, LLC

  • Psychologist
  • Bowling Green, KY
  • NPI 1265574396

  KY

  Medicare reassignment NPD

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669593600000",
    "number": "1497049977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 HIGH ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421012541",
            "telephone_number": "270-782-1116",
            "fax_number": "270-782-9108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 HIGH ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421012541",
            "telephone_number": "270-782-1116",
            "fax_number": "270-782-9108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUSMAN",
        "first_name": "HEATHER",
        "middle_name": "HAZELWOOD",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-02",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100293210",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lacarra Darnes
• Daniel Sundar Das, MD
• Allison Lee Daugherty
• Bailee Daugherty
• Kevin D. Daugherty, D.M.D.
• Emily G. Davenport, PT
• David a. Buchanan, D.M.D.
• David Glenn Smith MD LLC
• Rebecca Rene David, MS, ATC, LAT
• Randall P. Davidson, MD

• All providers in Bowling Green, KY
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.