Provider Demographics
NPI:1649469529
Name:HEISLER, TINA ANN (MS, LP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:HEISLER
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26246 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56591-9998
Mailing Address - Country:US
Mailing Address - Phone:218-983-3286
Mailing Address - Fax:218-983-3724
Practice Address - Street 1:26246 CRANE RD
Practice Address - Street 2:
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591-9998
Practice Address - Country:US
Practice Address - Phone:218-983-3286
Practice Address - Fax:218-983-3724
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200604103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist