Provider Demographics
NPI:1063498087
Name:HEIN, SUSAN A (MED APSW CADC III)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:HEIN
Suffix:
Gender:F
Credentials:MED APSW CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SOUTH 8TH ST
Mailing Address - Street 2:STE G-20
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-457-8866
Mailing Address - Fax:920-457-8867
Practice Address - Street 1:615 SOUTH 8TH ST
Practice Address - Street 2:STE G-20
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-457-8866
Practice Address - Fax:920-457-8867
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WI1191121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker