Provider Demographics
NPI:1528217114
Name:PAULSEN, HEIDI (RD, ATC, BCTMB)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:RD, ATC, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 RAMONA LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-6718
Mailing Address - Country:US
Mailing Address - Phone:636-345-2375
Mailing Address - Fax:
Practice Address - Street 1:1335 RAMONA LN
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-6718
Practice Address - Country:US
Practice Address - Phone:636-477-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120188422255A2300X
MO2005007414225700000X
MO2005010724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist