Doctor Name: | WILLIAM FREDRICK HEINEKE |
NPI Number: | 1083751416 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ED. D. |
License Number: | LPC346 |
Business Practice Address: | 501 S. Burma Ave. Gillette, WY - 82717 |
Business Phone Number: | 3076885000 |
Business Fax Number: | 3076885015 |
Mailing Address: | P.o. Box 3011, GILLETTE |
State: | WY |
Postal Code: | 82717 |
Phone Number: | 3076885000 |
Fax Number: | 3076885015 |
NPI Enumeration Date: | 02/01/2007 |
NPI Last Update Date: | 01/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | LPC346 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |