Healthcare Provider Details

I. General information

NPI: 1285759589
Provider Name (Legal Business Name): MS. KAREN B HEIDEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN B SCHULZ PHD

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS#115
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD MS#115
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2350
  • Fax:
Mailing address:
  • Phone: 323-361-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 18945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: