Provider Demographics
NPI:1356628259
Name:HELLER, WENDY JO (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:JO
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 1:1100 CRESTLINE PL
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1515
Mailing Address - Country:US
Mailing Address - Phone:516-719-6000
Mailing Address - Fax:
Practice Address - Street 1:1100 CRESTLINE PL
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1515
Practice Address - Country:US
Practice Address - Phone:516-719-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004424-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist