Provider Demographics
NPI:1003208851
Name:BANCROFT, HEATHER ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANN
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6415 SONNY DR APT 8
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-9038
Mailing Address - Country:US
Mailing Address - Phone:920-365-4417
Mailing Address - Fax:920-338-9121
Practice Address - Street 1:W6415 SONNY DR APT 8
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-9038
Practice Address - Country:US
Practice Address - Phone:920-365-4417
Practice Address - Fax:920-338-9121
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist