Basic Information
| Provider Information | |||||||||
| NPI: | 1881843902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEINRICHS | ||||||||
| FirstName: | ROBIN | ||||||||
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| Credential: | PHD | ||||||||
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| OtherLastName: | MATSON | ||||||||
| OtherFirstName: | ROBIN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1010 N. KANSAS | ||||||||
| Address2: | SUITE #3049 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162932647 | ||||||||
| FaxNumber: | 3162931882 | ||||||||
| Practice Location | |||||||||
| Address1: | 7829 E ROCKHILL ST | ||||||||
| Address2: | SUITE #105 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162933850 | ||||||||
| FaxNumber: | 3166836733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2008 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 1744 | KS | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.