Healthcare Provider Details

I. General information

NPI: 1003523069
Provider Name (Legal Business Name): CHRISTINA MARIE HEDDINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E BRACKLIN ST
RICE LAKE WI
54868-2644
US

IV. Provider business mailing address

616 E BRACKLIN ST
RICE LAKE WI
54868-2644
US

V. Phone/Fax

Practice location:
  • Phone: 715-415-3502
  • Fax:
Mailing address:
  • Phone: 715-415-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12133-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: