Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XM0800X | Mental Health | 3246-26 | WI |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 3246-26 | WI |
NPI | 1871003418 |
---|---|
Provider Name | Ms. Heidi Jennifer Adriansen |
First Address | Shorewood, WI 53211-1743 |
Second Address | Shorewood, WI 53211-1743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2017 |
Last Update Date | 10/10/2017 |