Provider Demographics
NPI:1679616973
Name:HECKART, GERALDINE LEE (LSCSW LCSW)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:LEE
Last Name:HECKART
Suffix:
Gender:F
Credentials:LSCSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:134 N 130TH STREET
Mailing Address - Street 2:#C
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012
Mailing Address - Country:US
Mailing Address - Phone:913-522-5140
Mailing Address - Fax:913-721-1399
Practice Address - Street 1:134 N 130TH ST
Practice Address - Street 2:#C SUNNY DAYS CLINICAL SERVICES
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012
Practice Address - Country:US
Practice Address - Phone:913-522-5140
Practice Address - Fax:913-721-1399
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 17821041C0700X
MOLCSW 20030206191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS29105Medicaid
KS29105Medicaid