Healthcare Provider Details

I. General information

NPI: 1427363324
Provider Name (Legal Business Name): CANDY HEYEN M.S., G.C.G, L.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8091 TOWNSHIP LINE RD SUITE 108
INDIANAPOLIS IN
46260-2494
US

IV. Provider business mailing address

1313 VALLEYGRASS DR
BROWNSBURG IN
46112-7888
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-8100
  • Fax:
Mailing address:
  • Phone: 317-625-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number74000019A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: