Provider Demographics
NPI:1427064922
Name:HEFFERNAN, MARGARET M (PHD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3365
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-2937
Practice Address - Street 1:927 S 8TH ST
Practice Address - Street 2:STE 307A
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4542
Practice Address - Country:US
Practice Address - Phone:920-683-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI267EUW103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39146900Medicaid
WI39146900Medicaid