Healthcare Provider Details

I. General information

NPI: 1982174645
Provider Name (Legal Business Name): SHAUNA HEIDELBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N COTTONWOOD ST
WOODLAND CA
95695-6646
US

IV. Provider business mailing address

5814 LEON AVE
MARYSVILLE CA
95901-6112
US

V. Phone/Fax

Practice location:
  • Phone: 530-661-2917
  • Fax:
Mailing address:
  • Phone: 916-470-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: