Provider Demographics
NPI:1942991682
Name:HEINDL, AMANDA KATHERINE (APSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHERINE
Last Name:HEINDL
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 183RD ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6435
Mailing Address - Country:US
Mailing Address - Phone:507-317-2752
Mailing Address - Fax:
Practice Address - Street 1:345 FRENETTE DR STE 4
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3072
Practice Address - Country:US
Practice Address - Phone:507-317-2752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134215-121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health