Provider Demographics
NPI:1982722898
Name:HEIZLER, PATRICIA J (BSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:J
Last Name:HEIZLER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:N2996 WELSH COULEE RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2734
Mailing Address - Country:US
Mailing Address - Phone:608-786-0130
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST
Practice Address - Street 2:STE. 100
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3301
Practice Address - Country:US
Practice Address - Phone:608-785-6266
Practice Address - Fax:608-785-6315
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1416171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator