Provider Demographics
NPI:1992919229
Name:HEITKAMP, MELANIE L (LICSW)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:L
Last Name:HEITKAMP
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 W ROSSER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3755
Mailing Address - Country:US
Mailing Address - Phone:701-255-6909
Mailing Address - Fax:701-255-3922
Practice Address - Street 1:217 W ROSSER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3755
Practice Address - Country:US
Practice Address - Phone:701-255-6909
Practice Address - Fax:701-255-3922
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
023892OtherBCBS OF ND
6192001OtherGROUP BCBS ND
ND19157Medicaid