Provider Demographics
NPI:1063739423
Name:HEIMANN, DANA MICHELLE
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:MICHELLE
Last Name:HEIMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 GREEN MOUNT CROSSING DR
Mailing Address - Street 2:SUITE 246
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7287
Mailing Address - Country:US
Mailing Address - Phone:618-977-6762
Mailing Address - Fax:
Practice Address - Street 1:4020 GREEN MOUNT CROSSING DR
Practice Address - Street 2:SUITE 246
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7287
Practice Address - Country:US
Practice Address - Phone:618-977-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021042066103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst