Provider Demographics
NPI:1538330469
Name:HEFFERNAN, JOANNE (SP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 QUAKER LN
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1667
Mailing Address - Country:US
Mailing Address - Phone:401-886-6600
Mailing Address - Fax:
Practice Address - Street 1:800 QUAKER LN
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1667
Practice Address - Country:US
Practice Address - Phone:401-886-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00489235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist