Basic Information
| Provider Information | |||||||||
| NPI: | 1033576186 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUNKS | ||||||||
| FirstName: | HEIDI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1924 W A ST | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689015650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024617578 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1924 W A ST | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 689015650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024617578 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2016 | ||||||||
| LastUpdateDate: | 01/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | NE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 4736001013 | 05 | NE | MEDICAID |