Provider Demographics
NPI:1114416294
Name:HEVENER, KATHLEEN RAE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RAE
Last Name:HEVENER
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 1:7349 WEST BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5272
Mailing Address - Country:US
Mailing Address - Phone:330-501-3132
Mailing Address - Fax:
Practice Address - Street 1:17 N CHAMPION ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44503-1636
Practice Address - Country:US
Practice Address - Phone:330-480-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator