Provider Demographics
NPI:1093596165
Name:HETZER, NATALIE LYNN I
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:LYNN
Last Name:HETZER
Suffix:I
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 1:1900 E 15TH ST STE 800B
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6682
Mailing Address - Country:US
Mailing Address - Phone:405-455-6868
Mailing Address - Fax:405-562-3444
Practice Address - Street 1:4127 NW 122ND ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8880
Practice Address - Country:US
Practice Address - Phone:405-455-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician