Provider Demographics
NPI:1093001711
Name:HAYWORTH, HEATHER MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:HAYWORTH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15009 CATLIN-TILTON RD.
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834
Mailing Address - Country:US
Mailing Address - Phone:217-443-8273
Mailing Address - Fax:217-443-0217
Practice Address - Street 1:15009 CATLIN TILTON RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834
Practice Address - Country:US
Practice Address - Phone:217-443-8273
Practice Address - Fax:217-443-0217
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist