Provider Demographics
NPI:1962103911
Name:HEIDENTHAL, KATHLEEN SUSAN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:HEIDENTHAL
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 1:765 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3018
Mailing Address - Country:US
Mailing Address - Phone:440-446-0765
Mailing Address - Fax:
Practice Address - Street 1:765 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3018
Practice Address - Country:US
Practice Address - Phone:440-446-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker