Provider Demographics
NPI:1700160488
Name:HEINZE, STEVEN FRED (HAD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:FRED
Last Name:HEINZE
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:331-229-8208
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:5089 S 1500 W
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3969
Practice Address - Country:US
Practice Address - Phone:801-866-1312
Practice Address - Fax:801-627-8020
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5496870-4601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist