Active NPI
Jeanette Myers Heitman
- Speech-Language Pathologist
- Lake Mills, WI
National Provider Identifier
1033384763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 556154
- Practice address
- 510 College St
Lake Mills, WI 53551-1411 - Phone
- (920) 648-2951
- NPI assigned
- Apr 23, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 556154 | WI | Primary |
Addresses
Primary practice location
510 College St
Lake Mills, WI 53551-1411
Mailing address
510 College St
Lake Mills, WI 53551-1411
Phone (920) 648-2951
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42651700 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 556154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208908800000",
"number": "1033384763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 COLLEGE ST",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535511411",
"telephone_number": "920-648-2951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 COLLEGE ST",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535511411",
"telephone_number": "920-648-2951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEITMAN",
"first_name": "JEANETTE",
"middle_name": "MYERS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-23",
"last_updated": "2008-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "556154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42651700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Mills, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.