Healthcare Provider Details

I. General information

NPI: 1780748269
Provider Name (Legal Business Name): HEATHER ANN PETERSOHN MILLER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 8TH AVE SUITE 3000
KENOSHA WI
53143-5031
US

IV. Provider business mailing address

6308 8TH AVE SUITE 3000
KENOSHA WI
53143-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-656-3300
  • Fax: 262-656-3265
Mailing address:
  • Phone: 262-656-3300
  • Fax: 262-656-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number355-156
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number355-156
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number355-156
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number355-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: