Provider Demographics
NPI:1043822406
Name:HEIGHWAY, DIANE KATHERINE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KATHERINE
Last Name:HEIGHWAY
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 1:19500 WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3752
Mailing Address - Country:US
Mailing Address - Phone:262-212-0477
Mailing Address - Fax:
Practice Address - Street 1:3505 N 124TH ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2489
Practice Address - Country:US
Practice Address - Phone:414-431-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor