Provider Demographics
NPI:1497036628
Name:HELGESON DONAUBAUER, HEIDI J (LMT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:J
Last Name:HELGESON DONAUBAUER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36872 N LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9349
Mailing Address - Country:US
Mailing Address - Phone:224-456-4347
Mailing Address - Fax:
Practice Address - Street 1:3021 FALLING WATERS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-6745
Practice Address - Country:US
Practice Address - Phone:847-356-2895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist