Provider Demographics
NPI:1972613016
Name:HEIMLER, HEIDI (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:HEIMLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11947
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-0947
Mailing Address - Country:US
Mailing Address - Phone:414-259-3900
Mailing Address - Fax:414-963-0000
Practice Address - Street 1:2015 E NEWPORT AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2984
Practice Address - Country:US
Practice Address - Phone:414-259-3900
Practice Address - Fax:414-963-0000
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2592-057103T00000X
MI6301009248103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39151300Medicaid