Provider Demographics
NPI:1215295944
Name:SCOFIELD, HEATHER MADDEN (MSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MADDEN
Last Name:SCOFIELD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WILLOW AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0827
Mailing Address - Country:US
Mailing Address - Phone:712-256-4420
Mailing Address - Fax:
Practice Address - Street 1:500 WILLOW AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0827
Practice Address - Country:US
Practice Address - Phone:712-256-4420
Practice Address - Fax:712-256-4423
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8025104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1010744Medicaid