Provider Demographics
NPI:1053855841
Name:HEINLEIN, CAROL JANE (PC-IT, SAC-IT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JANE
Last Name:HEINLEIN
Suffix:
Gender:F
Credentials:PC-IT, SAC-IT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:J
Other - Last Name:KRIEFALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:171 CHESTNUT STREET
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-0071
Mailing Address - Country:US
Mailing Address - Phone:715-339-3048
Mailing Address - Fax:715-339-2436
Practice Address - Street 1:171 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1313
Practice Address - Country:US
Practice Address - Phone:715-339-3048
Practice Address - Fax:715-339-2436
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker