Provider Demographics
NPI:1104079979
Name:HERON, MARLENE S (BS)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:S
Last Name:HERON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 VINING RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9784
Mailing Address - Country:US
Mailing Address - Phone:616-225-8220
Mailing Address - Fax:616-225-8226
Practice Address - Street 1:6728 VINING RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-9784
Practice Address - Country:US
Practice Address - Phone:616-225-8220
Practice Address - Fax:616-225-8226
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)