Provider Demographics
NPI:1598288946
Name:GROETZENBACH, HEATHER J (SLP)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:J
Last Name:GROETZENBACH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 N 42ND RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IL
Mailing Address - Zip Code:60551-9773
Mailing Address - Country:US
Mailing Address - Phone:630-917-7679
Mailing Address - Fax:
Practice Address - Street 1:10 SARAVANOS RD
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-5814
Practice Address - Country:US
Practice Address - Phone:630-553-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242004365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist