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NPI Code Detail

MEDICARE: RICHARD A. HEISE PHD

MEDICARE: RICHARD A. HEISE PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistR0350MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396773065
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD A. HEISE PHD
Provider Business Mailing Address
First Line : 111 W PORT PLZ STE 600
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-3015
Country : US
Telephone Number : 314-399-9707
Fax Number : 314-474-0119
Provider Business Practice Location Address
First Line : 111 W PORT PLZ STE 600
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-3015
Country : US
Telephone Number : 314-399-9707
Fax Number : 314-474-0119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 02/21/2023

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