Provider Demographics
NPI:1649413980
Name:EILERS, HEIDI (PHD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:EILERS
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1369
Mailing Address - Country:US
Mailing Address - Phone:714-425-1680
Mailing Address - Fax:
Practice Address - Street 1:9620 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1369
Practice Address - Country:US
Practice Address - Phone:714-425-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA #1041965103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst