Individual provider Active NPI

Karlene Elaine Heinz

  • Speech-Language Pathologist
  • Grand Forks, ND
National Provider Identifier
1962791012
Registry record updated Nov 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
1144 Issued in ND
Practice address
2400 47TH Ave S
Grand Forks, ND 58201-3405
Phone
(701) 746-2230
NPI assigned
Mar 29, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 1144 ND Primary

Addresses

Primary practice location

2400 47TH Ave S
Grand Forks, ND 58201-3405

Mailing address

2700 S 34TH St
# 120
Grand Forks, ND 58201-6045
Phone (406) 390-0261

Other identifiers 1

IdentifierTypeStateIssuer
55746MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1144NDMDMassage Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320796800000",
    "number": "1962791012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 S 34TH ST",
            "address_2": "# 120",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582016045",
            "telephone_number": "406-390-0261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 47TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013405",
            "telephone_number": "701-746-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINZ",
        "first_name": "KARLENE",
        "middle_name": "ELAINE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-29",
        "last_updated": "2011-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "1144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55746",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.