Healthcare Provider Details

I. General information

NPI: 1407003627
Provider Name (Legal Business Name): HEIDI SUSAN CRAMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEIDI SUSAN FRIESE

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 S 76TH ST # 305
GREENFIELD WI
53220-4364
US

IV. Provider business mailing address

3968 S 1ST PL
MILWAUKEE WI
53207-4308
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-7741
  • Fax: 414-325-7753
Mailing address:
  • Phone: 414-949-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number993062
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7008-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: