Provider Demographics
NPI:1457671471
Name:HEINZ, MICHELE LEE (MS SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LEE
Last Name:HEINZ
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SUNBURST LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2388
Mailing Address - Country:US
Mailing Address - Phone:309-444-4906
Mailing Address - Fax:800-773-1682
Practice Address - Street 1:508 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-1525
Practice Address - Country:US
Practice Address - Phone:800-773-1682
Practice Address - Fax:800-773-1682
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-005422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09117725OtherASHA CERTIFICATE OF CLINICAL COMPETENCE
IL146-005422OtherILLINIOS DEPARTMENT OF PROFESSIONAL REGULATIONS LICENSE NUMBER