Provider Demographics
NPI:1871714535
Name:WELLS, HEATHER SUE (BPHIL)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:SUE
Last Name:WELLS
Suffix:
Gender:F
Credentials:BPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6297 STONEWALL LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4631
Mailing Address - Country:US
Mailing Address - Phone:513-829-3108
Mailing Address - Fax:513-887-3709
Practice Address - Street 1:140 N 5TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3532
Practice Address - Country:US
Practice Address - Phone:513-863-6128
Practice Address - Fax:513-863-0524
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical