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NPI Code Detail

MEDICARE: HEATHER PETTINE SAC-IT

MEDICARE: HEATHER PETTINE SAC-IT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor21058WI

General Provider Information

NPI Number : 1730048174
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER PETTINE SAC-IT
Provider Business Mailing Address
First Line : 255 W BROADWAY
Second Line :
City : WAUKESHA
State : WI
Zip : 53186-4832
Country : US
Telephone Number : 262-420-9088
Fax Number : 262-458-4102
Provider Business Practice Location Address
First Line : 255 W BROADWAY
Second Line :
City : WAUKESHA
State : WI
Zip : 53186-4832
Country : US
Telephone Number : 262-420-9088
Fax Number : 262-458-4102
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2026
Last Update Date : 01/21/2026

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Directions to “ HEATHER PETTINE SAC-IT” Practice Location

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