Provider Demographics
NPI:1063498087
Name:HEIN, SUSAN A (MED APSW CADC III)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:HEIN
Suffix:
Gender:F
Credentials:MED APSW CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-457-4090
Mailing Address - Fax:920-453-0207
Practice Address - Street 1:601 N. 5TH STREET
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-457-4090
Practice Address - Fax:920-453-0207
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1191121104100000X
101YA0400X, 101YP2500X
WI1114-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health