1982606901 NPI number — MRS. ARLENE T HEYNEN MSW LISW

Table of content: MRS. ARLENE T HEYNEN MSW LISW (NPI 1982606901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982606901 NPI number — MRS. ARLENE T HEYNEN MSW LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEYNEN
Provider First Name:
ARLENE
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LISW
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1982606901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 S SYCAMORE AVE STE 105-3
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57110-1255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-334-3739
Provider Business Mailing Address Fax Number:
605-334-7752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 CENTRAL AVE NW STE 300
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51041-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-737-2635
Provider Business Practice Location Address Fax Number:
712-737-2344
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  LISW #02586 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 363864095 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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