Provider Demographics
NPI:1871990010
Name:HEATON, SUSANNE (LCSW)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:HEATON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 89TH AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8126
Mailing Address - Country:US
Mailing Address - Phone:219-736-4067
Mailing Address - Fax:
Practice Address - Street 1:303 E 89TH AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8126
Practice Address - Country:US
Practice Address - Phone:219-736-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340005378A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical