MEDICARE: MS. HEIDI ALISON BEAVER MPH, CGC

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1710975677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEIDI ALISON BEAVER MPH, CGC

Provider Business Mailing Address
First Line	:	3023 NORTH BALLAS ROAD
Second Line	:	SUITE 630
City	:	ST. LOUIS
State	:	MO
Zip	:	63131
Country	:	US
Telephone Number	:	314-996-6977
Fax Number	:	314-747-0704

Provider Business Practice Location Address
First Line	:	3023 NORTH BALLAS ROAD
Second Line	:	SUITE 630
City	:	ST. LOUIS
State	:	MO
Zip	:	63131
Country	:	US
Telephone Number	:	314-996-6977
Fax Number	:	314-747-0704

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/11/2018

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