Provider Demographics
NPI:1639709801
Name:HEINZE, KRISTEN ANNE (LISW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:HEINZE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:WAYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:520 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-3811
Mailing Address - Country:US
Mailing Address - Phone:319-398-3562
Mailing Address - Fax:319-398-3501
Practice Address - Street 1:1039 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6665
Practice Address - Country:US
Practice Address - Phone:319-338-7884
Practice Address - Fax:319-338-7006
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0954791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074575Medicaid