Provider Demographics
NPI:1497946362
Name:HEINE, DAVYE JANETTE (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:DAVYE
Middle Name:JANETTE
Last Name:HEINE
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:MS
Other - First Name:DAVYE
Other - Middle Name:JANETTE
Other - Last Name:GLASSCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5443
Mailing Address - Country:US
Mailing Address - Phone:573-634-3070
Mailing Address - Fax:573-636-3247
Practice Address - Street 1:1115 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5443
Practice Address - Country:US
Practice Address - Phone:573-634-3070
Practice Address - Fax:573-636-3247
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist