Provider Demographics
NPI:1649997479
Name:TEED, HEATHER SUSANNE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUSANNE
Last Name:TEED
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 1:932 N MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1285
Mailing Address - Country:US
Mailing Address - Phone:231-272-2379
Mailing Address - Fax:
Practice Address - Street 1:932 N MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1285
Practice Address - Country:US
Practice Address - Phone:231-272-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician