Healthcare Provider Details

I. General information

NPI: 1548133481
Provider Name (Legal Business Name): ANN ELIZABETH HEYEN MS RDN LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNIE ELIZABETH MALLON MS RDN LDN

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11141 QUEENSWAY DR
SAINT LOUIS MO
63146-4975
US

IV. Provider business mailing address

876 KING RD APT A
NEWARK OH
43055-2200
US

V. Phone/Fax

Practice location:
  • Phone: 314-252-8555
  • Fax:
Mailing address:
  • Phone: 314-252-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.11116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: