Provider Demographics
NPI:1356161384
Name:RIMSTIDT, HEATHER (PHD, NCSP, HSPP)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:RIMSTIDT
Suffix:
Gender:F
Credentials:PHD, NCSP, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 S FIELDSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-8962
Mailing Address - Country:US
Mailing Address - Phone:847-848-6614
Mailing Address - Fax:
Practice Address - Street 1:1200 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6001
Practice Address - Country:US
Practice Address - Phone:812-376-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16134842103TS0200X
IN20043506B103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool