Provider Demographics
NPI:1598059743
Name:PERNITZ, HEIDI (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:PERNITZ
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15460 W CAPITOL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2632
Mailing Address - Country:US
Mailing Address - Phone:262-264-8497
Mailing Address - Fax:262-244-2632
Practice Address - Street 1:15460 W CAPITOL DR STE 200
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2632
Practice Address - Country:US
Practice Address - Phone:262-264-8497
Practice Address - Fax:262-244-2632
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4663-125101YP2500X, 101YM0800X
WI16455-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)