Provider Demographics
NPI:1114027075
Name:HECKELBECK, MARILYN JOAN (HIS)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:JOAN
Last Name:HECKELBECK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 WASHINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-2251
Mailing Address - Country:US
Mailing Address - Phone:660-646-7110
Mailing Address - Fax:660-646-7110
Practice Address - Street 1:614 WASHINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2251
Practice Address - Country:US
Practice Address - Phone:660-646-7110
Practice Address - Fax:660-646-7110
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0725237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20958-01-9-SPEC-085OtherBLUE CROSS/ BLUE SHIELD I