Provider Demographics
NPI:1053504688
Name:WARNER, HEIDI L (PHD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:WARNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 99TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3887
Mailing Address - Country:US
Mailing Address - Phone:515-270-0200
Mailing Address - Fax:
Practice Address - Street 1:3230 99TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3887
Practice Address - Country:US
Practice Address - Phone:515-270-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1053504688Medicaid
IA1053504688Medicaid