Provider Demographics
NPI:1215445481
Name:HEIN, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HEIN
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 1:2902 22ND ST APT 6
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6787
Mailing Address - Country:US
Mailing Address - Phone:517-662-2206
Mailing Address - Fax:
Practice Address - Street 1:9001 MILLER RD STE 5
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473
Practice Address - Country:US
Practice Address - Phone:989-401-2244
Practice Address - Fax:800-562-3347
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician