Provider Demographics
NPI:1801150180
Name:WARD, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:KIRKSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4250 PLAZA ORO LOMA
Mailing Address - Street 2:APT. D
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4352
Mailing Address - Country:US
Mailing Address - Phone:618-559-2221
Mailing Address - Fax:
Practice Address - Street 1:1201 N MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6104
Practice Address - Country:US
Practice Address - Phone:907-257-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW13571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker