Healthcare Provider Details

I. General information

NPI: 1356161384
Provider Name (Legal Business Name): HEATHER RIMSTIDT PHD, NCSP, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CENTRAL AVE
COLUMBUS IN
47201-6001
US

IV. Provider business mailing address

540 S FIELDSTONE BLVD
BLOOMINGTON IN
47403-8962
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-4489
  • Fax:
Mailing address:
  • Phone: 847-848-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number16134842
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20043506B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: