Provider Demographics
NPI:1053656470
Name:HECKENKAMP, DAWN L (LPC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:L
Last Name:HECKENKAMP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2372
Mailing Address - Country:US
Mailing Address - Phone:608-477-9858
Mailing Address - Fax:877-560-0578
Practice Address - Street 1:708 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2372
Practice Address - Country:US
Practice Address - Phone:608-477-9858
Practice Address - Fax:877-560-0578
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4110-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional