Provider Demographics
NPI:1265688204
Name:HEINRICY, MELISSA MARIE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARIE
Last Name:HEINRICY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 - 29TH ST NE
Mailing Address - Street 2:STE A
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3452
Mailing Address - Country:US
Mailing Address - Phone:319-246-8782
Mailing Address - Fax:319-286-8798
Practice Address - Street 1:1825 - 29TH ST NE
Practice Address - Street 2:STE A
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3452
Practice Address - Country:US
Practice Address - Phone:319-246-8782
Practice Address - Fax:319-286-8798
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA532231H00000X
IA805237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
F228696OtherMIDLANDS CHOICE
7739065OtherAETNA