Provider Demographics
NPI:1902954670
Name:KAMMER HODGE, HEIDI ELIZABETH (MSW, LICSW, LADC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:ELIZABETH
Last Name:KAMMER HODGE
Suffix:
Gender:F
Credentials:MSW, LICSW, LADC
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:ELIZABETH
Other - Last Name:KAMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW, LADC
Mailing Address - Street 1:PO BOX 21306
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-0306
Mailing Address - Country:US
Mailing Address - Phone:612-804-3417
Mailing Address - Fax:
Practice Address - Street 1:4358 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2846
Practice Address - Country:US
Practice Address - Phone:612-804-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YA0400X
MN152031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical