Healthcare Provider Details

I. General information

NPI: 1427064922
Provider Name (Legal Business Name): MARGARET M HEFFERNAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 S 8TH ST STE 307A
MANITOWOC WI
54220-4542
US

IV. Provider business mailing address

1001 W GLEN OAKS LN SUITE 170
MEQUON WI
53092-3365
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-2090
  • Fax:
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number267EUW
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: