Provider Demographics
NPI:1689236531
Name:WENNESHEIMER, HEIDI MARIE
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:MARIE
Last Name:WENNESHEIMER
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 1:1234 MAIN ST STE 21
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-1307
Mailing Address - Country:US
Mailing Address - Phone:920-360-0241
Mailing Address - Fax:
Practice Address - Street 1:1234 MAIN ST STE 21
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1307
Practice Address - Country:US
Practice Address - Phone:920-360-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health