Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | ||
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1053989541 |
---|---|
Provider Name | Heidi Simon |
First Address | Quincy, CA 95971-9375 |
Second Address | Susanville, CA 96130-5029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 10/08/2021 |