Provider Demographics
NPI:1700405784
Name:HEIDLEBAUGH, ALEXIS RAE (SCM)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RAE
Last Name:HEIDLEBAUGH
Suffix:
Gender:F
Credentials:SCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HAMM DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7496
Mailing Address - Country:US
Mailing Address - Phone:570-551-0559
Mailing Address - Fax:
Practice Address - Street 1:120 HAMM DR STE 2A
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7496
Practice Address - Country:US
Practice Address - Phone:570-551-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS