Individual
PHILLIP NORMAN HEISTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1226 LAKE ST, WHITE LAKE, WI 54491-9750
(715) 882-8107
Mailing address
1226 LAKE ST, WHITE LAKE, WI 54491-9750
(715) 882-8107
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
237700000X
WI
Other
Enumeration date
02/23/2012
Last updated
02/23/2012
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