Provider Demographics
NPI:1790027563
Name:OLIVER, HEIDI A (PSYD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:OLIVER
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 1:5500 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1607
Mailing Address - Country:US
Mailing Address - Phone:316-685-2221
Mailing Address - Fax:
Practice Address - Street 1:2432 E QUIVIRA CT
Practice Address - Street 2:
Practice Address - City:KECHI
Practice Address - State:KS
Practice Address - Zip Code:67067-8909
Practice Address - Country:US
Practice Address - Phone:301-800-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP-2657103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical