1679616973 NPI number — MS. GERALDINE LEE HECKART LSCSW LCSW

Table of content: MS. GERALDINE LEE HECKART LSCSW LCSW (NPI 1679616973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679616973 NPI number — MS. GERALDINE LEE HECKART LSCSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HECKART
Provider First Name:
GERALDINE
Provider Middle Name:
LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LSCSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679616973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 N 130TH STREET
Provider Second Line Business Mailing Address:
#C
Provider Business Mailing Address City Name:
BONNER SPRINGS
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-522-5140
Provider Business Mailing Address Fax Number:
913-721-1399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 N 130TH ST
Provider Second Line Business Practice Location Address:
#C SUNNY DAYS CLINICAL SERVICES
Provider Business Practice Location Address City Name:
BONNER SPRINGS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-522-5140
Provider Business Practice Location Address Fax Number:
913-721-1399
Provider Enumeration Date:
02/15/2007

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:  LSCSW 1782 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW 2003020619 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 29105 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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