Provider Demographics
NPI:1760521249
Name:STODDARD, HEIDI HENGSTENBERG (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:HENGSTENBERG
Last Name:STODDARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ALLENTOWN PKWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4200
Mailing Address - Country:US
Mailing Address - Phone:972-359-1077
Mailing Address - Fax:972-359-8236
Practice Address - Street 1:100 ALLENTOWN PKWY
Practice Address - Street 2:SUITE 114
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4200
Practice Address - Country:US
Practice Address - Phone:972-359-1077
Practice Address - Fax:972-359-8236
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3-1063103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0089JNOtherBLUE CROSS &BLUE SHIELD