Provider Demographics
NPI:1396169983
Name:HEISEN, ERIKA
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:HEISEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 DOUBLE EAGLE DR UNIT 803
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1766
Mailing Address - Country:US
Mailing Address - Phone:630-267-1192
Mailing Address - Fax:
Practice Address - Street 1:135 N ARLINGTON HEIGHTS RD STE 195
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-8214
Practice Address - Country:US
Practice Address - Phone:312-321-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001127171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist