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General NPI Number Information
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NPI Number | 1053855841
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Entity Type | Individual
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Provider Name | CAROL JANE HEINLEIN PC-IT, SAC-IT
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Gender | Female
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 171 CHESTNUT ST
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City | PHILLIPS
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State | WI
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Zip | 54555-1313
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Country | US
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Telephone | 715-339-3048
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Fax | 715-339-2436
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Provider Business Mailing Address
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Address Line | PO BOX 71 171 CHESTNUT STREET
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City | PHILLIPS
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State | WI
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Zip | 54555-0071
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Country | US
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Telephone | 715-339-3048
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Fax | 715-339-2436
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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