Provider Demographics
NPI:1457610750
Name:ROEN, HEATHER HILDA (MS, LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:HILDA
Last Name:ROEN
Suffix:
Gender:F
Credentials:MS, LPC, CSAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:HILDA
Other - Last Name:KOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC-IT SAC-IT
Mailing Address - Street 1:1000 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-1821
Mailing Address - Country:US
Mailing Address - Phone:715-858-4850
Mailing Address - Fax:715-858-4513
Practice Address - Street 1:1000 STARR AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-1821
Practice Address - Country:US
Practice Address - Phone:715-858-4850
Practice Address - Fax:715-858-4513
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15625132101YA0400X
WI5003-123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457610750Medicaid