Provider Demographics
NPI:1093003147
Name:HEBERT, HEATHER LEIGH (RDMS, RVT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:HEBERT
Suffix:
Gender:F
Credentials:RDMS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 N 2110 EAST RD
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-6059
Mailing Address - Country:US
Mailing Address - Phone:815-432-2621
Mailing Address - Fax:815-432-0900
Practice Address - Street 1:1801 N STATE ROUTE 1
Practice Address - Street 2:BUILDING 3, SUITE 1
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-7562
Practice Address - Country:US
Practice Address - Phone:815-432-0100
Practice Address - Fax:815-432-0900
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL92627246XS1301X
IL500484028247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist