Provider Demographics
NPI:1790058857
Name:HEIMANN, BRADLEY VINCENT (BA, BS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:VINCENT
Last Name:HEIMANN
Suffix:
Gender:M
Credentials:BA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4885 ASTER ST
Mailing Address - Street 2:APT 10
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6695
Mailing Address - Country:US
Mailing Address - Phone:520-975-7928
Mailing Address - Fax:
Practice Address - Street 1:1790 W LLTH AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-686-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health