Provider Demographics
NPI:1386841120
Name:HAWKINS, HEATHER MARIE (LPTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-2790
Mailing Address - Country:US
Mailing Address - Phone:618-939-1862
Mailing Address - Fax:
Practice Address - Street 1:7733 FORSYTH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1817
Practice Address - Country:US
Practice Address - Phone:800-677-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005000831174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist