Provider Demographics
NPI:1073564803
Name:HEFFELFINGER MILES, AMY K (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:K
Last Name:HEFFELFINGER MILES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC NEUROPSYCHOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5660
Mailing Address - Fax:414-259-9012
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC NEUROPSYCHOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5660
Practice Address - Fax:414-259-9012
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2275103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1073564803Medicaid
004006261BOtherHUMANA
WI736011946Medicare PIN
WI1073564803Medicaid