Provider Demographics
NPI:1639721640
Name:HEPLER, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HEPLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STONIER LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:WI
Mailing Address - Zip Code:53582-9798
Mailing Address - Country:US
Mailing Address - Phone:608-341-8600
Mailing Address - Fax:
Practice Address - Street 1:1155 N ELM ST STE 120
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-1207
Practice Address - Country:US
Practice Address - Phone:608-348-4060
Practice Address - Fax:608-348-4191
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7135-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health