Provider Demographics
NPI:1669801031
Name:HEILING, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HEILING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12002 W 101ST ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-1962
Mailing Address - Country:US
Mailing Address - Phone:913-492-2840
Mailing Address - Fax:888-824-0616
Practice Address - Street 1:12002 W 101ST ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1962
Practice Address - Country:US
Practice Address - Phone:913-492-2840
Practice Address - Fax:888-824-0616
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS200971880A251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services