Provider Demographics
NPI:1164897229
Name:FACCINI, HEIDI (CCC/LSP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:FACCINI
Suffix:
Gender:F
Credentials:CCC/LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4610
Mailing Address - Country:US
Mailing Address - Phone:631-650-1911
Mailing Address - Fax:
Practice Address - Street 1:35 CARMAN RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5651
Practice Address - Country:US
Practice Address - Phone:631-549-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist