Active NPI
Audrey Ruth Heinen, LISW
- Clinical Social Worker
- Chardon, OH
National Provider Identifier
1548335102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I7379
- Practice address
- 12557 Ravenwood Dr
Chardon, OH 44024-9009 - Phone
- (440) 285-3568
- Fax
- (440) 285-4552
- NPI assigned
- Nov 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | I7379 | OH | Primary |
Addresses
Primary practice location
12557 Ravenwood Dr
Chardon, OH 44024-9009
Mailing address
17030 Leggett Rd
Montville, OH 44064-9721
Phone (440) 968-0183
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I7379 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548335102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17030 LEGGETT RD",
"city": "MONTVILLE",
"state": "OH",
"postal_code": "440649721",
"telephone_number": "440-968-0183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12557 RAVENWOOD DR",
"city": "CHARDON",
"state": "OH",
"postal_code": "440249009",
"telephone_number": "440-285-3568",
"fax_number": "440-285-4552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEINEN",
"first_name": "AUDREY",
"middle_name": "RUTH",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I7379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chardon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.