1699856997 NPI number — MS. DIANNE S. HEYNEN MS, QMHP, LPC-MH

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699856997 NPI number — MS. DIANNE S. HEYNEN MS, QMHP, LPC-MH

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HEYNEN

Provider First Name:

DIANNE

Provider Middle Name:

S.

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

MS, QMHP, LPC-MH

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1699856997

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/09/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3520 S SPENCER BLVD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SIOUX FALLS

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57103-4653

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-360-2613

Provider Business Mailing Address Fax Number:

605-339-0710

Provider First Line Business Practice Location Address:

2701 S MINNESOTA AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SIOUX FALLS

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57105-4744

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-360-2613

Provider Business Practice Location Address Fax Number:

605-339-0710

Provider Enumeration Date:

10/17/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 101YM0800X , with the licence number:  LPCMH2048 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 15428 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 15428 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
• Identifier: 49974 . This is a "BCBS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 034T7 . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 22057 . This is a "SIOUX VALLEY HEALTH" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 39026 . This is a "WAUSAU BENEFITS" identifier . This identifiers is of the category "OTHER".
• Identifier: 50374 . This is a "TRICARE PRIME REMOTE" identifier . This identifiers is of the category "OTHER".
• Identifier: 65755 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 9212453 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 62413 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 87726 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 12345 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 49974 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".