Provider Demographics
NPI:1518982743
Name:HELLER, LEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:
Last Name:HELLER
Suffix:
Gender:F
Credentials:MD
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 1842
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78667-1842
Mailing Address - Country:US
Mailing Address - Phone:512-256-0318
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4684
Practice Address - Country:US
Practice Address - Phone:512-245-2161
Practice Address - Fax:512-245-9288
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000068M8Medicaid
TX00068MMedicare ID - Type Unspecified
TXP000068M8Medicaid