Provider Demographics
NPI:1982112405
Name:ANGLISS, HEATHER LEE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEE
Last Name:ANGLISS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:LEE
Other - Last Name:MEGNIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ADOLFSECKER WEG 11B
Mailing Address - Street 2:
Mailing Address - City:BAD SCHWALBACH
Mailing Address - State:HESSEN
Mailing Address - Zip Code:65307
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ADOLFSECKER WEG 11B
Practice Address - Street 2:
Practice Address - City:BAD SCHWALBACH
Practice Address - State:HESSEN
Practice Address - Zip Code:65307
Practice Address - Country:DE
Practice Address - Phone:017-532-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-22936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst