Provider Demographics
NPI:1558652453
Name:HEAGNEY, MARILYN VIRGINIA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:VIRGINIA
Last Name:HEAGNEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 LAUREL COVE RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-2475
Mailing Address - Country:US
Mailing Address - Phone:704-528-8290
Mailing Address - Fax:
Practice Address - Street 1:448 LAUREL COVE RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-2475
Practice Address - Country:US
Practice Address - Phone:704-528-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist