Organization
HEALTHY MINDS OF THE FOX VALLEY LLC
Active
Organization
HEALTHY MINDS OF THE FOX VALLEY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY LEE HIETPAS PHD (OWNER)
(715) 937-8819
Entity
Organization
Contact information
Practice address
1045 N LYNNDALE DR, STE 1C, APPLETON, WI 54914-3048
(902) 551-0013
Mailing address
6188 CLARKS RD, WINNECONNE, WI 54986-9760
(908) 551-0013
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
72200-1519
WI
Other
Enumeration date
05/28/2015
Last updated
06/10/2015
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