Individual
MISS HEATHER MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
4000 W SPENCER ST, APPLETON, WI 54914-4015
(920) 735-9010
Mailing address
4000 W SPENCER ST, APPLETON, WI 54914-4015
(920) 735-9010
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16145-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16145-130
STATE OF WISCONSIN LICENSE SAC-IT NUMBER
WI
Enumeration date
11/02/2010
Last updated
11/02/2010
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