Provider Demographics
NPI:1942884267
Name:HEGGESETH, JOLIE (MFT-IT)
Entity type:Individual
Prefix:MRS
First Name:JOLIE
Middle Name:
Last Name:HEGGESETH
Suffix:
Gender:F
Credentials:MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3075
Mailing Address - Country:US
Mailing Address - Phone:920-725-1230
Mailing Address - Fax:920-215-6164
Practice Address - Street 1:145 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3075
Practice Address - Country:US
Practice Address - Phone:920-725-1230
Practice Address - Fax:920-215-6164
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI783-225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty