Provider Demographics
NPI:1952601833
Name:RIVERA, HEIDI JO (APSW, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:APSW, CSAC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:RUBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3812
Mailing Address - Country:US
Mailing Address - Phone:087-564-6386
Mailing Address - Fax:
Practice Address - Street 1:113 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3812
Practice Address - Country:US
Practice Address - Phone:608-756-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16098-130101YA0400X
WI15941101YA0400X
WI131330104100000X
WI131330-121104100000X
WI15941-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker