Provider Demographics
NPI:1083632236
Name:HECKLER, JENNIFER (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HECKLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HARBERT DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-5117
Mailing Address - Country:US
Mailing Address - Phone:937-427-1919
Mailing Address - Fax:937-427-1949
Practice Address - Street 1:115 HARBERT DR
Practice Address - Street 2:SUITE B
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-5117
Practice Address - Country:US
Practice Address - Phone:937-427-1919
Practice Address - Fax:937-427-1949
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist