1316393226 NPI number — MRS. HEIDI ANN PRITZL LCSW

Table of content: MRS. HEIDI ANN PRITZL LCSW (NPI 1316393226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316393226 NPI number — MRS. HEIDI ANN PRITZL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRITZL
Provider First Name:
HEIDI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARNS
Provider Other First Name:
HEIDI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316393226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 MAPLE ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODRUFF
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-356-8740
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MAPLE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODRUFF
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-356-8740
Provider Business Practice Location Address Fax Number:
715-356-8525
Provider Enumeration Date:
05/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  8109-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 8109-123LCSW , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: IN PROCESS OF ENROLL , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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