Healthcare Provider Details

I. General information

NPI: 1285325639
Provider Name (Legal Business Name): AMANDA HEITZER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 YORK AVE
BOARDMAN OH
44512-5615
US

IV. Provider business mailing address

5560 MADRID DR
AUSTINTOWN OH
44515-4155
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-3339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: