Provider Demographics
NPI:1548496193
Name:HEIMAN, KENDALL D (LSCSW, LCAC)
Entity type:Individual
Prefix:MS
First Name:KENDALL
Middle Name:D
Last Name:HEIMAN
Suffix:
Gender:F
Credentials:LSCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 NEW HAMPSHIRE ST STE 26
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3044
Mailing Address - Country:US
Mailing Address - Phone:785-371-1455
Mailing Address - Fax:866-493-2129
Practice Address - Street 1:1040 NEW HAMPSHIRE ST
Practice Address - Street 2:SUITE 26
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3044
Practice Address - Country:US
Practice Address - Phone:785-371-1455
Practice Address - Fax:866-493-2129
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS40681041C0700X
KS192101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)