Provider Demographics
NPI:1053135210
Name:WREN, HEIDI ILENE
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ILENE
Last Name:WREN
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 1:611 S HIGHWAY 78 STE 123
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4112
Mailing Address - Country:US
Mailing Address - Phone:903-821-1437
Mailing Address - Fax:866-874-2850
Practice Address - Street 1:611 S HIGHWAY 78 STE 123
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4112
Practice Address - Country:US
Practice Address - Phone:903-821-1437
Practice Address - Fax:866-874-2850
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician