Provider Demographics
NPI:1831530955
Name:WHITEAKER DUDERSTADT, HEIDI LYNN (LCPC, LAC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:WHITEAKER DUDERSTADT
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-2329
Mailing Address - Country:US
Mailing Address - Phone:785-915-9452
Mailing Address - Fax:785-748-4761
Practice Address - Street 1:213 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-2329
Practice Address - Country:US
Practice Address - Phone:785-915-9452
Practice Address - Fax:785-748-4761
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS943101YA0400X
KS2333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201146140AMedicaid