Healthcare Provider Details

I. General information

NPI: 1942026497
Provider Name (Legal Business Name): CURT L HEFNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4885 HIGHLANDER LN
SPRINGFIELD OH
45502-8343
US

IV. Provider business mailing address

4885 HIGHLANDER LN
SPRINGFIELD OH
45502-8343
US

V. Phone/Fax

Practice location:
  • Phone: 937-244-0314
  • Fax: 937-390-6736
Mailing address:
  • Phone: 937-244-0314
  • Fax: 937-390-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: