Provider Demographics
NPI:1528206745
Name:FRIESZ HEIDEL, HOLLEY ANNE (SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:HOLLEY
Middle Name:ANNE
Last Name:FRIESZ HEIDEL
Suffix:
Gender:F
Credentials:SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TRILAND COURT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249
Mailing Address - Country:US
Mailing Address - Phone:618-581-5998
Mailing Address - Fax:
Practice Address - Street 1:13 TRILAND COURT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249
Practice Address - Country:US
Practice Address - Phone:618-581-5998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist