Provider Demographics
NPI:1023649050
Name:KIACZ, HEIDI MARIE (LSC, NCC, MA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:KIACZ
Suffix:
Gender:F
Credentials:LSC, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2739
Mailing Address - Country:US
Mailing Address - Phone:616-928-5048
Mailing Address - Fax:
Practice Address - Street 1:3310 EAGLE PARK DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4574
Practice Address - Country:US
Practice Address - Phone:616-915-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health