Provider Demographics
NPI:1184089245
Name:HAWES, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HAWES
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 1:1752 DORSET LN
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2452
Mailing Address - Country:US
Mailing Address - Phone:171-524-6991
Mailing Address - Fax:
Practice Address - Street 1:1752 DORSET LN
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2452
Practice Address - Country:US
Practice Address - Phone:171-524-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1132-124106H00000X
WI9931-120104100000X
MN19588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist