Provider Demographics
NPI:1699307637
Name:HEAGWOOD, KATRENA MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:KATRENA
Middle Name:MICHELLE
Last Name:HEAGWOOD
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 1:1321 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1725
Mailing Address - Country:US
Mailing Address - Phone:406-532-8400
Mailing Address - Fax:406-224-4402
Practice Address - Street 1:81 W PARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1713
Practice Address - Country:US
Practice Address - Phone:406-497-9000
Practice Address - Fax:406-723-7117
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-426271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical