Provider Demographics
NPI:1477886505
Name:VANLEEUWEN, HEATHER INEZ (AAS)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:INEZ
Last Name:VANLEEUWEN
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:INEZ
Other - Last Name:O'DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:604 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2026
Mailing Address - Country:US
Mailing Address - Phone:316-452-1199
Mailing Address - Fax:
Practice Address - Street 1:604 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2026
Practice Address - Country:US
Practice Address - Phone:316-452-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist