| Organization Name: | DR. ERICA WAGNER-HEIMANN & ASSOCIATES, LLC |
| NPI Number: | 1134465354 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERICA WAGNER-HEIMANN (LICENSED CLINICAL PSYCHOLOGIST) |
| Mailing Address: | 770 Lake Cook Rd Suite 230 Deerfield |
| State: | IL US |
| Postal Code: | 600154920 |
| Phone Number: | 8479208279 |
| Fax Number: | |
| NPI Enumeration Date: | 12/15/2012 |
| NPI Last Update Date: | 12/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 071008279 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |