Basic Information
| Provider Information | |||||||||
| NPI: | 1689099806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANVY | ||||||||
| FirstName: | HEATHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 NORTH GORE AVENUE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631191699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145357911 | ||||||||
| FaxNumber: | 3149682375 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 GRAVOIS RD | ||||||||
| Address2: | |||||||||
| City: | HOUSE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630512304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362966206 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2014 | ||||||||
| LastUpdateDate: | 10/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.