1922513647 NPI number — MRS. HEATHER ANDREA PERKINS LCSW

Table of content: MRS. HEATHER ANDREA PERKINS LCSW (NPI 1922513647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922513647 NPI number — MRS. HEATHER ANDREA PERKINS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
HEATHER
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
MRS.
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:
JONES
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922513647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 DODGE AVE UNIT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-4033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-677-6824
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1370 S WHITE OAK DR APT 121
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUKEGAN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60085-8345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-677-6824
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2017

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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