Individual
MRS. HEATHER LISA ILCONICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
30 S MAPLE AVE, MARLTON, NJ 08053-2002
(917) 647-2530
Mailing address
110 MOUNTAINVIEW RD, MOUNT LAUREL, NJ 08054-4729
(609) 410-0865
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05275300
NJ
Other
Enumeration date
05/29/2024
Last updated
05/29/2024
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