Provider Demographics
NPI:1073005757
Name:ROMATOWSKI, HEATHER R (BSW, SAC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:R
Last Name:ROMATOWSKI
Suffix:
Gender:F
Credentials:BSW, SAC
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
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:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16114-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7986-120OtherSOCIAL WORKER
WI16114-131OtherSUBSTANCE ABUSE COUNSELOR