Provider Demographics
NPI:1154331601
Name:NEUBURGER, HEIDI S
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:S
Last Name:NEUBURGER
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 1:705 RILEY HOSPITAL DR
Mailing Address - Street 2:0860
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5128
Mailing Address - Country:US
Mailing Address - Phone:317-948-5818
Mailing Address - Fax:317-944-6680
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:0860
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5128
Practice Address - Country:US
Practice Address - Phone:317-948-5818
Practice Address - Fax:317-944-6680
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002212A231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200636230Medicaid