MEDICARE: KIRSTEN LEIGH HEYNEN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BA-01495	IA

General Provider Information

NPI Number	:	1104777101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN LEIGH HEYNEN BCBA

Provider Business Mailing Address
First Line	:	4280 SERGEANT RD STE 230
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4634
Country	:	US
Telephone Number	:	515-207-5251
Fax Number	:

Provider Business Practice Location Address
First Line	:	4280 SERGEANT RD STE 230
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4634
Country	:	US
Telephone Number	:	515-207-5251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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