Healthcare Provider Details

I. General information

NPI: 1437209426
Provider Name (Legal Business Name): MARK E. HEINTZELMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 HOSBROOK RD SUITE 402
CINCINNATI OH
45236-2994
US

IV. Provider business mailing address

8050 HOSBROOK RD SUITE 402
CINCINNATI OH
45236-2994
US

V. Phone/Fax

Practice location:
  • Phone: 513-794-0083
  • Fax: 513-792-3652
Mailing address:
  • Phone: 513-794-0083
  • Fax: 513-792-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3577
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: