Provider Demographics
NPI:1861798910
Name:CARNEY, HEATHER DALE
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:DALE
Last Name:CARNEY
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 1:606 WASTENA ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-3447
Mailing Address - Country:US
Mailing Address - Phone:618-927-1366
Mailing Address - Fax:
Practice Address - Street 1:606 WASTENA ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-3447
Practice Address - Country:US
Practice Address - Phone:618-927-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency