Individual
JERRY WAYNE HEATHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW-S
Contact information
Practice address
4750 WESLEY AVE STE J, CINCINNATI, OH 45212-2276
(513) 531-5110
(513) 531-5668
Mailing address
4750 WESLEY AVE STE J, CINCINNATI, OH 45212-2276
(513) 531-5110
(513) 531-5668
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I 0005389 SUPV
OH
Other
Enumeration date
08/10/2012
Last updated
08/10/2012
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