Provider Demographics
NPI:1982055463
Name:SCHILDT, HEIDI (MSE)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:SCHILDT
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 LORI ANN DR
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1927
Mailing Address - Country:US
Mailing Address - Phone:608-289-0945
Mailing Address - Fax:
Practice Address - Street 1:400 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6200
Practice Address - Country:US
Practice Address - Phone:608-368-8087
Practice Address - Fax:608-312-2061
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2223-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional