Healthy Minds of the Fox Valley LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

72200-1519 Issued in WI

Legal business name

HEALTHY MINDS OF THE FOX VALLEY LLC

Practice address

1045 N Lynndale Dr
Ste 1C
Appleton, WI 54914-3048

Phone

(902) 551-0013

NPI assigned

May 28, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tammy Lee Hietpas, PHD

Title

Owner

Phone

(715) 937-8819

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1518346261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6188 CLARKS RD",
            "city": "WINNECONNE",
            "state": "WI",
            "postal_code": "549869760",
            "telephone_number": "908-551-0013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 N LYNNDALE DR",
            "address_2": "STE 1C",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549143048",
            "telephone_number": "902-551-0013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY MINDS OF THE FOX VALLEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-28",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "HIETPAS",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-937-8819",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "72200-1519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Appleton, WI
• Providers in Appleton, WI by specialty
• Clinical Neuropsychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.