Provider Demographics
NPI:1861058539
Name:MCKINNON, HEATHER (CSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:UT
Mailing Address - Zip Code:84086-0233
Mailing Address - Country:US
Mailing Address - Phone:801-688-2699
Mailing Address - Fax:
Practice Address - Street 1:1186 E 4600 S STE 200
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5097
Practice Address - Country:US
Practice Address - Phone:801-688-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT345794-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker