Provider Demographics
NPI:1275698375
Name:AUSTIN, HEATHER (LAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3410 MENDOCINO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2244
Mailing Address - Country:US
Mailing Address - Phone:707-528-7696
Mailing Address - Fax:707-596-4941
Practice Address - Street 1:3410 MENDOCINO AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2244
Practice Address - Country:US
Practice Address - Phone:707-528-7696
Practice Address - Fax:707-596-4941
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC11379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist