=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427363324
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDY HEYEN M.S., G.C.G, L.G.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2010
-----------------------------------------------------
Last Update Date | 08/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8091 TOWNSHIP LINE RD SUITE 108
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-2494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-415-8100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1313 VALLEYGRASS DR
-----------------------------------------------------
City | BROWNSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46112-7888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-625-3482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number | 74000019A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------