Provider Demographics
NPI:1821686346
Name:ENGELHARDT, HEIDI B (LAC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:B
Last Name:ENGELHARDT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 N 85TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2828
Mailing Address - Country:US
Mailing Address - Phone:141-468-7318
Mailing Address - Fax:
Practice Address - Street 1:163 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1603
Practice Address - Country:US
Practice Address - Phone:414-687-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI999-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist