Provider Demographics
NPI:1326263898
Name:HEARTHSTONE THERAPY & CONSULTING LLC
Entity Type:Organization
Organization Name:HEARTHSTONE THERAPY & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-282-8353
Mailing Address - Street 1:4810 S 76TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4360
Mailing Address - Country:US
Mailing Address - Phone:414-282-8353
Mailing Address - Fax:414-536-8605
Practice Address - Street 1:4810 S 76TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4360
Practice Address - Country:US
Practice Address - Phone:414-282-8353
Practice Address - Fax:414-536-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI372421OtherHEALTHNET
WI228716OtherVALUEOPTIONS PROVIDER
WI=========019OtherBLUE CROSS BLUE SHIELD
WI372421OtherHEALTHNET
WI000044830Medicare ID - Type UnspecifiedMEDICARE NUMBER