Provider Demographics
NPI:1104132679
Name:ELWOOD, HEIDI SM (LCSW)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:SM
Last Name:ELWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:S
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 SW HIGGINS AVE
Mailing Address - Street 2:STE 207
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1340
Mailing Address - Country:US
Mailing Address - Phone:406-404-6191
Mailing Address - Fax:
Practice Address - Street 1:900 N ORANGE ST
Practice Address - Street 2:STE 202
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2951
Practice Address - Country:US
Practice Address - Phone:406-327-1670
Practice Address - Fax:406-329-5697
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical