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Contact Information

TAMMY L HIETPAS, PHD
1095 MIDWAY RD
MENASHA, WI54952
 Phone: 920-720-2300
 Fax: 920-720-3719
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
 

Clinical Neuropsychologist

103G00000X
Indicates primary specialty

NPI Profile & details for TAMMY L HIETPAS · (Female)

NPI Number 1396055307
Status Active
Credentials PHD
Entity Individual
Enumeration date 10/13/2010
Last updated 11/30/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 2889
  • WI License # 2889-057
  • WI Medicaid 100011985
Hospital affiliation(s)
  • ST CLARE'S HOSPITAL OF WESTON INC - (Acute Care)
    3400 MINISTRY PARKWAY
    WESTON, WI 54476
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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