Michael J Heidtman
Individual provider Active NPI Clinical Social Worker · Little Chute, WI
NPI 1285213124 · NPPES record last updated Apr 7, 2021
Key facts
- NPI
- 1285213124
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 8764-123 (WI)
- Practice address
- 103 W Greenfield Dr
Little Chute, WI 54140-1115 - Phone
- (906) 362-8544
- NPI assigned
- Apr 7, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8764-123 | WI | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | 8764-123 | WI | Yes |
Addresses
Primary practice location
103 W Greenfield Dr
Little Chute, WI 54140-1115
Mailing address
103 W Greenfield Dr
Little Chute, WI 54140-1115
Phone (906) 362-8544
Other providers in Little Chute, WI
- Elite Smiles Little Chute, LLC
- Amy Marie Fifield
- Fox Valley Family Eye Care SC
- Brieanna M Haroldson
- Lisa Hartjes
- Christina A Heindl
- Betsy Hermus
- Emily E Hietpas
- Kelsey Hietpas
- Tyler J Hietpas
All providers in Little Chute, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.