Provider Demographics
NPI:1619375755
Name:HEATHER HOEFEN DC INC
Entity Type:Organization
Organization Name:HEATHER HOEFEN DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEFEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-636-0011
Mailing Address - Street 1:258 HAYLER CT
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1108
Mailing Address - Country:US
Mailing Address - Phone:312-636-0011
Mailing Address - Fax:
Practice Address - Street 1:123 N HENRY ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-1822
Practice Address - Country:US
Practice Address - Phone:312-636-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4450012251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management