Provider Demographics
NPI:1376681064
Name:HEINTZ, LAURENE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURENE
Middle Name:
Last Name:HEINTZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:FESSENDEN
Mailing Address - State:ND
Mailing Address - Zip Code:58438-0067
Mailing Address - Country:US
Mailing Address - Phone:701-547-3296
Mailing Address - Fax:
Practice Address - Street 1:500 2 ST N
Practice Address - Street 2:
Practice Address - City:FESSENDEN
Practice Address - State:ND
Practice Address - Zip Code:58438-0067
Practice Address - Country:US
Practice Address - Phone:701-547-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND019015Medicaid