Provider Demographics
NPI:1386979276
Name:HERON, LINDA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:HERON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2616
Mailing Address - Country:US
Mailing Address - Phone:130-785-1395
Mailing Address - Fax:
Practice Address - Street 1:625 E MADISON AVE STE 6
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4712
Practice Address - Country:US
Practice Address - Phone:130-785-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW#6531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical