Provider Demographics
NPI:1508198920
Name:VETTER, HEIDI MARIE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:MARIE
Last Name:VETTER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SYCAMORE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1220
Mailing Address - Country:US
Mailing Address - Phone:909-273-6353
Mailing Address - Fax:
Practice Address - Street 1:1900 SYCAMORE CANYON RD # RE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1220
Practice Address - Country:US
Practice Address - Phone:909-929-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20915103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist