Healthcare Provider Details

I. General information

NPI: 1467915132
Provider Name (Legal Business Name): ABIGAIL J HEURING MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 12/13/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 VERNON BLVD STE 100
MADISON WI
53705-4964
US

IV. Provider business mailing address

414 DONOFRIO DR STE 330
MADISON WI
53719-2846
US

V. Phone/Fax

Practice location:
  • Phone: 608-455-8999
  • Fax:
Mailing address:
  • Phone: 920-470-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number666
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1347-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: