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General NPI Number Information
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NPI Number | 1336299478
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Entity Type | Individual
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Provider Name | HEIDI A GIBBONS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 3506 N US HIGHWAY 51
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City | JANESVILLE
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State | WI
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Zip | 53545-0726
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Country | US
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Telephone | 608-757-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 508 CHURCH ST
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City | CLINTON
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State | WI
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Zip | 53525-9493
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Country | US
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Telephone | 608-290-0842
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Fax |
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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 | 7154-123
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License Number State | WI
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