Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 71003954 | IL |
Y | 103TC0700X | Clinical Psychologist | 71003954 | IL |
NPI | 1003012790 |
---|---|
Provider Name | Dr. Wendy Heller |
First Address | Champaign, IL 61820-6232 |
Second Address | Champaign, IL 61820-5723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 08/07/2007 |