Healthcare Provider Details

I. General information

NPI: 1710853551
Provider Name (Legal Business Name): HEIDI BEGOVATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34700 VALLEY RD
OCONOMOWOC WI
53066-4500
US

IV. Provider business mailing address

2424 S 102ND ST
MILWAUKEE WI
53227-2106
US

V. Phone/Fax

Practice location:
  • Phone: 262-646-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20564
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: