Individual
JEANETTE MYERS HEITMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 COLLEGE ST, LAKE MILLS, WI 53551-1411
(920) 648-2951
Mailing address
510 COLLEGE ST, LAKE MILLS, WI 53551-1411
(920) 648-2951
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
556154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42651700
—
WI
Enumeration date
04/23/2008
Last updated
04/23/2008
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