Provider Demographics
NPI:1306536917
Name:PETERMANN, HEATHER (AUTISM SPECIALIST)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PETERMANN
Suffix:
Gender:F
Credentials:AUTISM SPECIALIST
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARCELLA
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVE STE E230
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2818
Mailing Address - Country:US
Mailing Address - Phone:785-587-1825
Mailing Address - Fax:785-587-1828
Practice Address - Street 1:1133 COLLEGE AVE STE E230
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2818
Practice Address - Country:US
Practice Address - Phone:785-587-1825
Practice Address - Fax:785-587-1828
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00000106S00000X, 103K00000X
KS103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician