Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 71003191 | IL |
NPI | 1366482572 |
---|---|
Provider Name | Dr. Allen Walter Heinemann |
First Address | Chicago, IL 60657-6534 |
Second Address | Chicago, IL 60657-6534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
925890 | (02) | IL |