Provider Demographics
NPI:1184797532
Name:HELLRUNG, MARIE-THERESE (MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:MARIE-THERESE
Middle Name:
Last Name:HELLRUNG
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:MARIE-THERESE
Other - Middle Name:
Other - Last Name:HEITKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7031 N ARDARA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2921
Mailing Address - Country:US
Mailing Address - Phone:414-899-7996
Mailing Address - Fax:
Practice Address - Street 1:5555 N PORT WASHINGTON RD STE 200
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4927
Practice Address - Country:US
Practice Address - Phone:262-789-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI740-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43709700Medicaid