Provider Demographics
NPI:1699513994
Name:GOODREAU, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:GOODREAU
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 1:320 W GRAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-2781
Mailing Address - Country:US
Mailing Address - Phone:715-421-1107
Mailing Address - Fax:
Practice Address - Street 1:320 W GRAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-2781
Practice Address - Country:US
Practice Address - Phone:715-421-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty