Provider Demographics
NPI:1073490652
Name:HEIDENREICH, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HEIDENREICH
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 1:9669 N 1600 EAST RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-5503
Mailing Address - Country:US
Mailing Address - Phone:309-826-9226
Mailing Address - Fax:
Practice Address - Street 1:2111 E OAKLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5783
Practice Address - Country:US
Practice Address - Phone:309-808-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032987176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife