Provider Demographics
NPI:1306860994
Name:HECKSEL, MARYROSE (MA)
Entity Type:Individual
Prefix:
First Name:MARYROSE
Middle Name:
Last Name:HECKSEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 W SAGINAW HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1131
Mailing Address - Country:US
Mailing Address - Phone:517-321-6801
Mailing Address - Fax:517-321-1737
Practice Address - Street 1:7201 W SAGINAW HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1131
Practice Address - Country:US
Practice Address - Phone:517-321-6801
Practice Address - Fax:517-321-1737
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH000135237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4758259Medicaid
MIP07880001Medicare ID - Type Unspecified