Provider Demographics
NPI:1073006334
Name:MARTYN, HEATHER MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:MARTYN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:DRURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1210 FOURIER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1969
Mailing Address - Country:US
Mailing Address - Phone:608-662-9327
Mailing Address - Fax:608-662-9041
Practice Address - Street 1:150 N SUNNY SLOPE RD STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4806
Practice Address - Country:US
Practice Address - Phone:262-432-5660
Practice Address - Fax:262-432-5666
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI234-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst