Provider Demographics
NPI:1114790086
Name:MATTSON, HEATHER (MSW, APSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MATTSON
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:HIETPAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22308
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2308
Mailing Address - Country:US
Mailing Address - Phone:920-436-6800
Mailing Address - Fax:920-432-5966
Practice Address - Street 1:1810 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1164
Practice Address - Country:US
Practice Address - Phone:920-739-4226
Practice Address - Fax:920-739-7639
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1329271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI132927OtherSTATE LICENSE