Provider Demographics
NPI:1770955536
Name:HEARTLAND PEDIATRIC FEEDING DISORDERS SERVICES
Entity type:Organization
Organization Name:HEARTLAND PEDIATRIC FEEDING DISORDERS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:515-771-6248
Mailing Address - Street 1:121 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:IA
Mailing Address - Zip Code:50171-8416
Mailing Address - Country:US
Mailing Address - Phone:515-771-6248
Mailing Address - Fax:
Practice Address - Street 1:121 HORSESHOE DR
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:IA
Practice Address - Zip Code:50171-8416
Practice Address - Country:US
Practice Address - Phone:515-771-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency