Healthcare Provider Details

I. General information

NPI: 1295293967
Provider Name (Legal Business Name): HEIDI ISAACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 COLLINGWOOD BLVD
TOLEDO OH
43610-1173
US

IV. Provider business mailing address

830 N SUMMIT ST STE 2
TOLEDO OH
43604-1884
US

V. Phone/Fax

Practice location:
  • Phone: 419-255-9585
  • Fax:
Mailing address:
  • Phone: 419-693-9600
  • Fax: 419-693-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: