Healthcare Provider Details

I. General information

NPI: 1073794467
Provider Name (Legal Business Name): HEIDI L LAMMON LPC, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 S RIVERSIDE DR SUITE 102
BELOIT WI
53511-1500
US

IV. Provider business mailing address

3005 S RIVERSIDE DR SUITE 102
BELOIT WI
53511-1500
US

V. Phone/Fax

Practice location:
  • Phone: 608-346-8315
  • Fax:
Mailing address:
  • Phone: 608-346-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5731-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3594-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: