Provider Demographics
NPI:1437685559
Name:HEIKKINEN, KARLA (RDN)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:
Last Name:HEIKKINEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1333
Mailing Address - Country:US
Mailing Address - Phone:920-723-5086
Mailing Address - Fax:
Practice Address - Street 1:515 MONROE ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1333
Practice Address - Country:US
Practice Address - Phone:920-723-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2825-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered