Individual
TAMMY L. HIETPAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1095 MIDWAY RD, MENASHA, WI 54952
(920) 720-2300
(920) 720-3719
Mailing address
122 E COLLEGE AVE, APPLETON, WI 54911-5794
(920) 996-3264
(920) 830-5910
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
2889-057
WI
103T00000X
Psychologist
Primary
2889
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100011985
—
WI
Enumeration date
10/13/2010
Last updated
11/30/2018
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