Provider Demographics
NPI:1093028094
Name:HESKETH, CAROL LYNN
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:HESKETH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:HESKETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:4878 WINTERWAY LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2319
Mailing Address - Country:US
Mailing Address - Phone:716-648-4796
Mailing Address - Fax:
Practice Address - Street 1:4878 WINTERWAY LN
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2319
Practice Address - Country:US
Practice Address - Phone:716-648-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008254-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist