=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821540717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI FEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2016
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9976 S PHOENIX DR
-----------------------------------------------------
City | MOHAVE VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86440-9565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-916-5819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 908 E LYNDALE DR
-----------------------------------------------------
City | TULARE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93274-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-916-5819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------