Provider Demographics
NPI:1033759543
Name:NAQUIN, HEATHER L
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:NAQUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 ARAGON RD
Mailing Address - Street 2:
Mailing Address - City:MONTEGUT
Mailing Address - State:LA
Mailing Address - Zip Code:70377-3322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:968 ARAGON RD
Practice Address - Street 2:
Practice Address - City:MONTEGUT
Practice Address - State:LA
Practice Address - Zip Code:70377-3322
Practice Address - Country:US
Practice Address - Phone:985-720-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1215365689Medicaid