Healthcare Provider Details

I. General information

NPI: 1194394783
Provider Name (Legal Business Name): MS. HEIDI HIRSOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 MARIA LN
WALNUT CREEK CA
94596-5343
US

IV. Provider business mailing address

1737 LAUREL ST
NAPA CA
94559-3229
US

V. Phone/Fax

Practice location:
  • Phone: 925-979-9052
  • Fax:
Mailing address:
  • Phone: 707-738-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: