Provider Demographics
NPI:1871128017
Name:ALLEN, HEIDI SUE
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:SUE
Last Name:ALLEN
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 1:1240 SUNSET TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:NE
Mailing Address - Zip Code:68865-1728
Mailing Address - Country:US
Mailing Address - Phone:308-660-3900
Mailing Address - Fax:
Practice Address - Street 1:3307 W CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1334
Practice Address - Country:US
Practice Address - Phone:308-382-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7345104100000X
NE11768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker