Provider Demographics
NPI:1043922826
Name:WALSBERGER VERHULST, HEIDI JO (CAPSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:WALSBERGER VERHULST
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E681 751ST AVE
Mailing Address - Street 2:
Mailing Address - City:KNAPP
Mailing Address - State:WI
Mailing Address - Zip Code:54749-9075
Mailing Address - Country:US
Mailing Address - Phone:715-764-0433
Mailing Address - Fax:715-268-0071
Practice Address - Street 1:230 DERONDA ST
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1412
Practice Address - Country:US
Practice Address - Phone:715-268-0074
Practice Address - Fax:715-268-0071
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132813-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical