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General NPI Number Information
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NPI Number | 1316145386
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Entity Type | Individual
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Provider Name | HEATHER ANN HEINRICH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 1365 FLOWERING DOGWOOD LN STE EANDF
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City | DYERSBURG
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State | TN
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Zip | 38024-2884
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Country | US
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Telephone | 731-439-4301
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Fax | 731-345-4333
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Provider Business Mailing Address
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Address Line | 710 US HIGHWAY 51 BYP W PMB 599
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City | DYERSBURG
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State | TN
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Zip | 38024-1950
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Country | US
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Telephone | 731-439-4301
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Fax | 731-439-4301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008012
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3481
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License Number State | TN
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