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NPI Code Detail

MEDICARE: MR. SCOTT EDWARD HEISE

MEDICARE: MR. SCOTT EDWARD HEISE
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1821328063
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT EDWARD HEISE
Provider Business Mailing Address
First Line : 33 N STEWART AVE
Second Line :
City : FREEPORT
State : IL
Zip : 61032-3780
Country : US
Telephone Number : 815-801-1260
Fax Number :
Provider Business Practice Location Address
First Line : 1122 HEALTHCARE DR
Second Line :
City : MOUNT CARROLL
State : IL
Zip : 61053-1461
Country : US
Telephone Number : 815-244-1376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2010
Last Update Date : 01/11/2010

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