Provider Demographics
NPI:1528713732
Name:WOOD, HEATHER VANDYKE (BASW LSW)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:VANDYKE
Last Name:WOOD
Suffix:
Gender:F
Credentials:BASW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MESSIMER DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1899
Mailing Address - Country:US
Mailing Address - Phone:740-345-7030
Mailing Address - Fax:
Practice Address - Street 1:69 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4983
Practice Address - Country:US
Practice Address - Phone:740-345-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS22122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker