Provider Demographics
NPI:1295041101
Name:ROSSETTI, HEIDI CHRISTINE (PHD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:CHRISTINE
Last Name:ROSSETTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVC SUITE BLA.110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8846
Mailing Address - Country:US
Mailing Address - Phone:214-648-4646
Mailing Address - Fax:214-648-4660
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-648-8701
Practice Address - Fax:214-648-5297
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36303103T00000X, 103G00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program