Provider Demographics
NPI:1114575701
Name:HELLER, ALLYSON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:HELLER
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 1:637 N BRIEGEL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1639
Mailing Address - Country:US
Mailing Address - Phone:314-541-7591
Mailing Address - Fax:
Practice Address - Street 1:637 N BRIEGEL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1639
Practice Address - Country:US
Practice Address - Phone:314-541-7591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242005594390200000X
MO2019031367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program