Provider Demographics
NPI:1841636438
Name:REARDON-NABBEFELD, HEATHER ANNE (MAC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANNE
Last Name:REARDON-NABBEFELD
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:REARDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4825 N APPLE RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9321
Mailing Address - Country:US
Mailing Address - Phone:920-993-6912
Mailing Address - Fax:
Practice Address - Street 1:N5367 MAYFLOWER RD
Practice Address - Street 2:
Practice Address - City:SHIOCTON
Practice Address - State:WI
Practice Address - Zip Code:54170-8934
Practice Address - Country:US
Practice Address - Phone:920-986-3003
Practice Address - Fax:920-986-3004
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional