Provider Demographics
NPI:1952068785
Name:HEARN, KOURTNEY NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:NICOLE
Last Name:HEARN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:NICOLE
Other - Last Name:STRAIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1689 S KNIK GOOSE BAY RD STE 700
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8088
Mailing Address - Country:US
Mailing Address - Phone:907-841-8663
Mailing Address - Fax:907-357-0115
Practice Address - Street 1:1689 S KNIK GOOSE BAY RD STE 700
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8088
Practice Address - Country:US
Practice Address - Phone:907-841-8663
Practice Address - Fax:907-357-0115
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2121831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical