Healthcare Provider Details

I. General information

NPI: 1063498087
Provider Name (Legal Business Name): SUSAN A HEIN MED APSW CADC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N. 5TH STREET
SHEBOYGAN WI
53081
US

IV. Provider business mailing address

601 N 5TH ST
SHEBOYGAN WI
53081
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4090
  • Fax: 920-453-0207
Mailing address:
  • Phone: 920-457-4090
  • Fax: 920-453-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1114-123
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1191121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: