Provider Demographics
NPI:1083929590
Name:HART, HEIDI LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNNE
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LYNNE
Other - Last Name:POYSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAPSW
Mailing Address - Street 1:1224 MARK AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-1166
Mailing Address - Country:US
Mailing Address - Phone:715-563-0818
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI104100000X
IL149.0222231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker