Provider Demographics
NPI:1386925485
Name:HEINLE, KRISTINA MARIE
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:HEINLE
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:ND
Mailing Address - Zip Code:58059
Mailing Address - Country:US
Mailing Address - Phone:701-428-3388
Mailing Address - Fax:
Practice Address - Street 1:506 1ST STREET
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:ND
Practice Address - Zip Code:58059
Practice Address - Country:US
Practice Address - Phone:701-428-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist