Provider Demographics
NPI:1508385642
Name:HEIDI SCHNEIDERHAN, LLC
Entity Type:Organization
Organization Name:HEIDI SCHNEIDERHAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDERHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC, ADS
Authorized Official - Phone:906-249-3642
Mailing Address - Street 1:708 CHIPPEWA SQ STE 11
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:708 CHIPPEWA SQ STE 11
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4814
Practice Address - Country:US
Practice Address - Phone:906-360-7603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010630421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty