Provider Demographics
NPI:1588190607
Name:MIKKELSON, HEATHER N (APSW, SACIT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:MIKKELSON
Suffix:
Gender:F
Credentials:APSW, SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1550
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-1550
Mailing Address - Country:US
Mailing Address - Phone:715-362-5745
Mailing Address - Fax:
Practice Address - Street 1:822 STILLWELL AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2217
Practice Address - Country:US
Practice Address - Phone:715-362-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101Y00000X, 101YA0400X, 101YM0800X
WI9240-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health