Healthcare Provider Details

I. General information

NPI: 1376584847
Provider Name (Legal Business Name): HEIDI J PENDLETON MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI J BAUER MSW, LCSW

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S GIBSON ST
MEDFORD WI
54451-1622
US

IV. Provider business mailing address

103 S GIBSON ST
MEDFORD WI
54451-1622
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-8112
  • Fax:
Mailing address:
  • Phone: 715-748-8112
  • Fax: 715-748-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7188
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: