Doctor Name: | STACY HEATWOLE |
NPI Number: | 1891118600 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. CCC/SLP |
License Number: | SP4928 |
Business Practice Address: | 470 Center St Bldg. 2 Chardon, OH - 440241098 |
Business Phone Number: | 4402791700 |
Business Fax Number: | |
Mailing Address: | 15920 Hemlock Rd, CHAGRIN FALLS |
State: | OH |
Postal Code: | 440223933 |
Phone Number: | 4402475212 |
Fax Number: | |
NPI Enumeration Date: | 01/30/2014 |
NPI Last Update Date: | 01/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP4928 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
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 |