Provider Demographics
NPI:1285618462
Name:WALIGORA, HEIDI LOUISE (MSW ACSW)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LOUISE
Last Name:WALIGORA
Suffix:
Gender:F
Credentials:MSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 LINE LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-2220
Mailing Address - Country:US
Mailing Address - Phone:715-682-3523
Mailing Address - Fax:715-682-3526
Practice Address - Street 1:301 ELLIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1667
Practice Address - Country:US
Practice Address - Phone:715-682-3523
Practice Address - Fax:715-682-3526
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010467061041C0700X
WI7534-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E26040038Medicare ID - Type Unspecified