1821706474 NPI number — MS. SALLY KATHERINE HETRICK LCSW

Table of content: MS. SALLY KATHERINE HETRICK LCSW (NPI 1821706474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821706474 NPI number — MS. SALLY KATHERINE HETRICK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HETRICK
Provider First Name:
SALLY
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WESCHLER
Provider Other First Name:
SALLY
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821706474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 N 60TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32506-4621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-424-8295
Provider Business Mailing Address Fax Number:
850-424-8296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 N 60TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32506-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-424-8295
Provider Business Practice Location Address Fax Number:
850-424-8296
Provider Enumeration Date:
11/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4529C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: SW24279 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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