Provider Demographics
NPI:1437767233
Name:MCDONALD, HEATHER LYNN (MS, ATR, LCP-IT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MS, ATR, LCP-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N METRO DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8572
Mailing Address - Country:US
Mailing Address - Phone:920-903-1009
Mailing Address - Fax:
Practice Address - Street 1:245 N METRO DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8572
Practice Address - Country:US
Practice Address - Phone:920-903-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional