MEDICARE: DR. SUSAN HEFFELFINGER PH.D

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
1	103TP2701X	Group Psychotherapy Psychologist	071006675	IL
2	103TC0700X	Clinical Psychologist	071-006675	IL

General Provider Information

NPI Number	:	1871736355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN HEFFELFINGER PH.D

Provider Business Mailing Address
First Line	:	159 GRAND OAKS LN
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3244
Country	:	US
Telephone Number	:	847-477-2297
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 GRAND OAKS LN
Second Line	:
City	:	DIXON
State	:	IL
Zip	:	61021-3244
Country	:	US
Telephone Number	:	847-477-2297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	03/24/2025

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