Provider Demographics
NPI:1346486602
Name:NACKLEY, HEATHER DRISCOLL (MED, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DRISCOLL
Last Name:NACKLEY
Suffix:
Gender:F
Credentials:MED, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6421
Mailing Address - Country:US
Mailing Address - Phone:814-941-7770
Mailing Address - Fax:
Practice Address - Street 1:601 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6421
Practice Address - Country:US
Practice Address - Phone:814-941-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT00631L231H00000X
PAAT000631L231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner