Provider Demographics
NPI:1508107178
Name:HEINEN, LEAH (RD LD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HEINEN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 120TH RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:KS
Mailing Address - Zip Code:66538-2539
Mailing Address - Country:US
Mailing Address - Phone:785-256-3987
Mailing Address - Fax:
Practice Address - Street 1:1366 120TH RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:KS
Practice Address - Zip Code:66538-2539
Practice Address - Country:US
Practice Address - Phone:785-256-3987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1258133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered