Healthcare Provider Details

I. General information

NPI: 1467223404
Provider Name (Legal Business Name): HEIDI LYNN WILMARTH MS, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2254 FLINT HILL DR STE 2
DUBUQUE IA
52003-8097
US

IV. Provider business mailing address

2254 FLINT HILL DR STE 2
DUBUQUE IA
52003-8097
US

V. Phone/Fax

Practice location:
  • Phone: 413-216-5423
  • Fax:
Mailing address:
  • Phone: 815-541-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. HEIDI LYNN WILMARTH
Title or Position: COUNSELOR- MENTAL HEALTH
Credential: MS
Phone: 815-541-5100