Provider Demographics
NPI:1033708664
Name:HEEHS, CILLE WILDS (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CILLE
Middle Name:WILDS
Last Name:HEEHS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CILLE
Other - Last Name:HEEHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:850 POPLAR AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4607
Mailing Address - Country:US
Mailing Address - Phone:901-287-7337
Mailing Address - Fax:
Practice Address - Street 1:4055 N PARK LOOP
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-6008
Practice Address - Country:US
Practice Address - Phone:901-678-2009
Practice Address - Fax:901-678-5497
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ067921Medicaid