Provider Demographics
NPI:1558443838
Name:HEINZ, AMBER LEIGH (MS/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LEIGH
Last Name:HEINZ
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5321 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9757
Mailing Address - Country:US
Mailing Address - Phone:920-733-1975
Mailing Address - Fax:
Practice Address - Street 1:1673 DOUSMAN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3209
Practice Address - Country:US
Practice Address - Phone:920-498-2599
Practice Address - Fax:920-498-2394
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2380-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist