Provider Demographics
NPI:1053466706
Name:HEINTZ, BROOKE A
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:HEINTZ
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:COMMANDER USA MEDDAC AK MCUC MMD
Mailing Address - Street 2:1060 GAFFNEY RD STE 7440
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7440
Mailing Address - Country:US
Mailing Address - Phone:907-353-5418
Mailing Address - Fax:907-353-4847
Practice Address - Street 1:COMMANDER USA MEDDAC AK MCUC MMD
Practice Address - Street 2:1060 GAFFNEY RD STE 7440
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7440
Practice Address - Country:US
Practice Address - Phone:907-353-5418
Practice Address - Fax:907-353-4847
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125363104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker