Provider Demographics
NPI:1467995035
Name:BLEEKE, HEATHER SUE (PSYD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUE
Last Name:BLEEKE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:SUE
Other - Last Name:JOHNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CRC, CCM
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11143 PARKVIEW PLAZA DR STE 320
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1728
Practice Address - Country:US
Practice Address - Phone:260-266-5370
Practice Address - Fax:260-266-5379
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004254A101YM0800X
IN20043888A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health