Provider Demographics
NPI:1215034269
Name:HECKERMAN, LEE ELLEN (LSCSW)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ELLEN
Last Name:HECKERMAN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:ELLEN
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4909 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1694
Mailing Address - Country:US
Mailing Address - Phone:316-619-1101
Mailing Address - Fax:
Practice Address - Street 1:1900 E. WASHINGTON
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66063
Practice Address - Country:US
Practice Address - Phone:620-378-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS19531041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004252460004Medicaid
KS200740390CMedicaid