MEDICARE: VICTORIA LEIGH HEATH 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
1	1041C0700X	Clinical Social Worker	11414	WI
2	101YM0800X	Mental Health Counselor	132016	WI

General Provider Information

NPI Number	:	1780256081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA LEIGH HEATH LCSW

Provider Business Mailing Address
First Line	:	N3152 STATE ROAD 81
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-8821
Country	:	US
Telephone Number	:	608-328-9352
Fax Number	:	608-328-9480

Provider Business Practice Location Address
First Line	:	N3152 STATE ROAD 81
Second Line	:
City	:	MONROE
State	:	WI
Zip	:	53566-8821
Country	:	US
Telephone Number	:	608-328-9393
Fax Number	:	608-325-2139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	02/27/2026

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