Healthcare Provider Details

I. General information

NPI: 1871736355
Provider Name (Legal Business Name): SUSAN HEFFELFINGER PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN HEFFELFINGER NAG PH.D

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 GRAND OAKS LN
DIXON IL
61021-3244
US

IV. Provider business mailing address

159 GRAND OAKS LN
DIXON IL
61021-3244
US

V. Phone/Fax

Practice location:
  • Phone: 847-477-2297
  • Fax:
Mailing address:
  • Phone: 847-477-2297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number071006675
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-006675
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: