Provider Demographics
NPI:1386940153
Name:HEISLER, COURTNEY (MSW)
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:
Last Name:HEISLER
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 1:794 N RODEO CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2301
Mailing Address - Country:US
Mailing Address - Phone:630-329-3870
Mailing Address - Fax:
Practice Address - Street 1:794 N RODEO CIR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-2301
Practice Address - Country:US
Practice Address - Phone:630-329-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1012490691041S0200X
IL23335641041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool