Provider Demographics
NPI:1063997674
Name:ALDRICH, HEIDI E
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:E
Last Name:ALDRICH
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 1:2130 CORAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6896
Mailing Address - Country:US
Mailing Address - Phone:386-576-7773
Mailing Address - Fax:
Practice Address - Street 1:2130 CORAL CREEK DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6896
Practice Address - Country:US
Practice Address - Phone:386-576-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-22-244533106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician