MEDICARE: MELISSA HEIDEBCRECHT

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	106S00000X	Behavior Technician	RBT-24-388469	CA

General Provider Information

NPI Number	:	1174331714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA HEIDEBCRECHT

Provider Business Mailing Address
First Line	:	6166 DILL CT
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95215-1003
Country	:	US
Telephone Number	:	209-616-7931
Fax Number	:

Provider Business Practice Location Address
First Line	:	6166 DILL CT
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95215-1003
Country	:	US
Telephone Number	:	209-616-7931
Fax Number	:

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

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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Directions to “ MELISSA HEIDEBCRECHT ” Practice Location

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