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General NPI Number Information
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NPI Number | 1407449598
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Entity Type | Individual
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Provider Name | HEATHER ELIZABETH DINKLAGE EDS
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Gender | Female
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 307 W 7TH ST
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City | LORAIN
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State | OH
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Zip | 44052-1813
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Country | US
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Telephone | 440-434-6320
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Fax |
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Provider Business Mailing Address
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Address Line | 309 W DUDLEY ST
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City | MAUMEE
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State | OH
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Zip | 43537-2116
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Country | US
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Telephone | 419-283-5790
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 21204854
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License Number State | OH
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