MEDICARE: DANIEL M HEISER PSYD

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	103TC0700X	Clinical Psychologist	PS020618	PA
2	103TC0700X	Clinical Psychologist	LP03497	KS
3	103TC0700X	Clinical Psychologist	4045	TN
4	103TC0700X	Clinical Psychologist	38934	TX
5	103TC0700X	Clinical Psychologist	20042232A	IN
6	103TC0700X	Clinical Psychologist	071010277	IL
7	103TC0700X	Clinical Psychologist	6301017024	MI
8	103TC0700X	Clinical Psychologist	P.08058	OH

General Provider Information

NPI Number	:	1396914875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL M HEISER PSYD

Provider Business Mailing Address
First Line	:	2100 N MAIN ST STE 304
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-1877
Country	:	US
Telephone Number	:	574-546-1900
Fax Number	:	574-546-1999

Provider Business Practice Location Address
First Line	:	6000 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3981
Country	:	US
Telephone Number	:	574-546-1900
Fax Number	:

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

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	01/16/2026

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