Individual
MR. JUSTIN MICHAEL HEILENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
25 WENTWORTH DR, WILLISTON, VT 05495-9733
(802) 878-4990
(802) 878-1477
Mailing address
711 NE RANDALL AVE, APT 303, PORTLAND, OR 97232-2384
(503) 890-7947
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089.0074343
VT
1041C0700X
Clinical Social Worker
4064
OR
Other
Enumeration date
01/16/2008
Last updated
01/20/2011
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