Provider Demographics
NPI:1104691088
Name:HEASTON, WILLIAM (MSW, SWC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HEASTON
Suffix:
Gender:M
Credentials:MSW, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 S ALTON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-7924
Mailing Address - Country:US
Mailing Address - Phone:402-210-8903
Mailing Address - Fax:
Practice Address - Street 1:1175 S ALTON ST UNIT B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-7924
Practice Address - Country:US
Practice Address - Phone:402-210-8903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.00000014451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty