Provider Demographics
NPI:1073621108
Name:HEILE, KATHERINE ELIZABETH (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:HEILE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:HEILE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:3850 W SUNNYSIDE AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6331
Mailing Address - Country:US
Mailing Address - Phone:773-539-3895
Mailing Address - Fax:
Practice Address - Street 1:2075 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2416
Practice Address - Country:US
Practice Address - Phone:847-432-9257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14458Medicare ID - Type Unspecified
209349Medicare ID - Type Unspecified