Provider Demographics
NPI:1063695856
Name:HECKEROTH, SHAWNA RAE (LCSW LAC)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:RAE
Last Name:HECKEROTH
Suffix:
Gender:F
Credentials:LCSW LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-0984
Mailing Address - Country:US
Mailing Address - Phone:406-531-5670
Mailing Address - Fax:406-363-5271
Practice Address - Street 1:310 N 4TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840
Practice Address - Country:US
Practice Address - Phone:406-531-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1174101YA0400X
MT7901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)