Individual
HEIDI NICOLE PHISTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC
Contact information
Practice address
1409 EMIL ST, MADISON, WI 53713-2311
(608) 283-6426
Mailing address
1409 EMIL ST, MADISON, WI 53713-2311
(608) 283-6426
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16539
WI
Other
Enumeration date
07/15/2022
Last updated
07/15/2022
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