| Doctor Name: | MRS. HEATHER KATHERINE GUSTISON |
| NPI Number: | 1063748937 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2004028834 |
| Business Practice Address: | 1005 Broadway St Quincy, IL - 623012834 |
| Business Phone Number: | 2172238400 |
| Business Fax Number: | 2172239945 |
| Mailing Address: | Po Box 7005, 14th And Broadway Po Box 7005 QUINCY |
| State: | IL |
| Postal Code: | 623057005 |
| Phone Number: | 2172238400 |
| Fax Number: | 2172239945 |
| NPI Enumeration Date: | 10/27/2009 |
| NPI Last Update Date: | 10/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2004028834 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |