Provider Demographics
NPI:1427573633
Name:HEISLER, ELIZABETH S
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:HEISLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W 6TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9160
Mailing Address - Country:US
Mailing Address - Phone:309-945-7032
Mailing Address - Fax:
Practice Address - Street 1:307 W 6TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9160
Practice Address - Country:US
Practice Address - Phone:815-219-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL140.012809235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist