Provider Demographics
NPI:1245592948
Name:HEITKER, SUSAN C (M S ED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:HEITKER
Suffix:
Gender:F
Credentials:M S ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLEARBROOK RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-1329
Mailing Address - Country:US
Mailing Address - Phone:914-999-3132
Mailing Address - Fax:914-999-3133
Practice Address - Street 1:200 CLEARBROOK RD STE 114
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-1329
Practice Address - Country:US
Practice Address - Phone:914-999-3132
Practice Address - Fax:914-999-3133
Is Sole Proprietor?:No
Enumeration Date:2012-06-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1708117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist