Provider Demographics
NPI:1669063509
Name:MANN, HEIDI ALIENE (BCBA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ALIENE
Last Name:MANN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ALIENE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 W 900 S
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:IN
Mailing Address - Zip Code:47234-9773
Mailing Address - Country:US
Mailing Address - Phone:317-512-3063
Mailing Address - Fax:317-663-2947
Practice Address - Street 1:120 W JACKSON ST STE B&C
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1295
Practice Address - Country:US
Practice Address - Phone:317-512-3063
Practice Address - Fax:317-663-2947
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-21-46959103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst