Individual
DR. NICHOLAS E. HEYNEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
850 E CENTER ST, SUITE A, POCATELLO, ID 83201-5737
(208) 234-7740
(208) 392-1541
Mailing address
24 YALE ST, POCATELLO, ID 83201-3436
(208) 234-7740
(208) 392-1541
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-234
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017340
REGENCE BLUE SHIELD
ID
01
—
N-2340
BLUE CROSS
ID
Enumeration date
12/08/2006
Last updated
02/03/2014
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