Healthcare Provider Details

I. General information

NPI: 1821518259
Provider Name (Legal Business Name): HEATHER LIEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 S YELLOWSTONE DR
MADISON WI
53719-2902
US

IV. Provider business mailing address

106 W SEEBOTH ST UNIT 220
MILWAUKEE WI
53204-4323
US

V. Phone/Fax

Practice location:
  • Phone: 608-205-8650
  • Fax:
Mailing address:
  • Phone: 815-701-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8021-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.013047
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.012581
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180012581
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012948
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: