Healthcare Provider Details

I. General information

NPI: 1639721640
Provider Name (Legal Business Name): SUSAN HEPLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N ELM ST STE 120
PLATTEVILLE WI
53818-1207
US

IV. Provider business mailing address

101 STONIER LN
RIDGEWAY WI
53582-9798
US

V. Phone/Fax

Practice location:
  • Phone: 608-348-4060
  • Fax: 608-348-4191
Mailing address:
  • Phone: 608-341-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7135-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: