Provider Demographics
NPI:1679883003
Name:DAVIS, HEATHER RENE (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 SE 28TH CT
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-3282
Mailing Address - Country:US
Mailing Address - Phone:785-554-3114
Mailing Address - Fax:
Practice Address - Street 1:2339 SE 28TH CT
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-3282
Practice Address - Country:US
Practice Address - Phone:785-554-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical