Provider Demographics
NPI:1174495584
Name:PETEE, HEATHER M (CPRS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:PETEE
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1319
Mailing Address - Country:US
Mailing Address - Phone:513-607-5128
Mailing Address - Fax:888-832-2040
Practice Address - Street 1:7 WILLOW ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1319
Practice Address - Country:US
Practice Address - Phone:513-607-5128
Practice Address - Fax:888-832-2040
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004512175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty