Provider Demographics
NPI:1003294794
Name:HECKENLIVELY, LINDA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:HECKENLIVELY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7501 MAY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3709
Mailing Address - Country:US
Mailing Address - Phone:925-829-0779
Mailing Address - Fax:925-829-0779
Practice Address - Street 1:320 LENNON LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2419
Practice Address - Country:US
Practice Address - Phone:925-906-2268
Practice Address - Fax:925-902-2255
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist