MEDICARE: HEIDI LYNN DEWITT

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-19-83430	NV

General Provider Information

NPI Number	:	1508341983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI LYNN DEWITT

Provider Business Mailing Address
First Line	:	2740 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5398
Country	:	US
Telephone Number	:	702-248-8866
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 W ANN RD STE 120
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4407
Country	:	US
Telephone Number	:	702-248-8866
Fax Number	:	702-323-6613

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

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	06/24/2019

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Directions to “ HEIDI LYNN DEWITT ” Practice Location

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