Individual
DR. MARK E. HEINTZELMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
8050 HOSBROOK RD, SUITE 402, CINCINNATI, OH 45236-2994
(513) 794-0083
(513) 792-3652
Mailing address
8050 HOSBROOK RD, SUITE 402, CINCINNATI, OH 45236-2994
(513) 794-0083
(513) 792-3652
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3577
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31-1210119
TAX IDENTIFICATION NUMBER
OH
Enumeration date
01/11/2007
Last updated
07/08/2007
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