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General NPI Number Information
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NPI Number | 1285618462
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Entity Type | Individual
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Provider Name | HEIDI LOUISE WALIGORA MSW ACSW
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Gender | Female
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 301 ELLIS AVE STE 1
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City | ASHLAND
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State | WI
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Zip | 54806-1667
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Country | US
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Telephone | 715-682-3523
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Fax | 715-682-3526
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Provider Business Mailing Address
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Address Line | 1922 LINE LEXINGTON RD
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City | HATFIELD
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State | PA
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Zip | 19440-2220
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Country | US
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Telephone | 715-682-3523
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Fax | 715-682-3526
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801046706
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7534-123
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License Number State | WI
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