Basic Information
| Provider Information | |||||||||
| NPI: | 1003012790 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HELLER | ||||||||
| FirstName: | WENDY | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 E DANIEL ST | ||||||||
| Address2: | PSYCHOLOGY DEPT. UIUC | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618206232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173330041 | ||||||||
| FaxNumber: | 2172445876 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 E GREEN ST | ||||||||
| Address2: | 3RD FLOOR, PSYCHOLOGICAL SERVICES CENTER | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618205723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173330041 | ||||||||
| FaxNumber: | 2173330064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 71003954 | IL | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.