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General NPI Number Information
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NPI Number | 1134465354
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Entity Type | Organization
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Legal Business Name | DR. ERICA WAGNER-HEIMANN & ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/15/2012
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Last Update Date | 12/15/2012
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Provider Practice Location Address
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Address Line | 770 LAKE COOK RD SUITE 230
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City | DEERFIELD
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State | IL
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Zip | 60015-4920
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Country | US
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Telephone | 847-920-8279
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Fax |
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Provider Business Mailing Address
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Address Line | 770 LAKE COOK RD SUITE 230
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City | DEERFIELD
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State | IL
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Zip | 60015-4920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. ERICA WAGNER-HEIMANN
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Credential | PSY.D.
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Telephone | 847-920-8279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 071008279
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License Number State | IL
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