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NPI Code Detail

MEDICARE: DIANNE M HEAPY MA, LCSW

MEDICARE: DIANNE M HEAPY MA, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2720-123WI

General Provider Information

NPI Number : 1518359322
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE M HEAPY MA, LCSW
Provider Business Mailing Address
First Line : 101 THOMPSON RD
Second Line :
City : WASHBURN
State : WI
Zip : 54891-4525
Country : US
Telephone Number : 715-373-2233
Fax Number : 715-373-5530
Provider Business Practice Location Address
First Line : 101 THOMPSON RD
Second Line :
City : WASHBURN
State : WI
Zip : 54891-4525
Country : US
Telephone Number : 715-373-2233
Fax Number : 715-373-5530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2015
Last Update Date : 03/03/2015

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