Provider Demographics
NPI:1770664344
Name:VANDEN HEUVEL, THOMAS J (LCSW, CEAP, SAC, SAP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:VANDEN HEUVEL
Suffix:
Gender:M
Credentials:LCSW, CEAP, SAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 SAINT PATRICK CIR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9776
Mailing Address - Country:US
Mailing Address - Phone:262-224-6468
Mailing Address - Fax:262-787-7909
Practice Address - Street 1:12012 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2040
Practice Address - Country:US
Practice Address - Phone:262-224-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7058-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40955100Medicaid
WI40955100Medicaid