Provider Demographics
NPI:1316663826
Name:WEINMASTER, HEATHER ANN (RBT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:WEINMASTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6394
Mailing Address - Country:US
Mailing Address - Phone:308-870-3873
Mailing Address - Fax:
Practice Address - Street 1:3300 MELISSA LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-6394
Practice Address - Country:US
Practice Address - Phone:308-870-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22-233946106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician