Provider Demographics
NPI:1295937944
Name:HEINZ, MELINDA DIANE
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:DIANE
Last Name:HEINZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:DIANE
Other - Last Name:HEINZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:250 PINGS RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-9557
Mailing Address - Country:US
Mailing Address - Phone:406-889-3570
Mailing Address - Fax:
Practice Address - Street 1:250 PINGS RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9557
Practice Address - Country:US
Practice Address - Phone:406-889-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT532610Medicaid