Provider Demographics
NPI:1720507585
Name:FORNEY, HEATHER MARIE (MS, CRC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:FORNEY
Suffix:
Gender:F
Credentials:MS, CRC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:FORNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 KESSEL CT STE 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:608-270-2800
Mailing Address - Fax:
Practice Address - Street 1:208 E OLIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1434
Practice Address - Country:US
Practice Address - Phone:608-280-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00101562171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator