Provider Demographics
NPI:1609381409
Name:CONIGLIO, HEATHER LANG (MSED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LANG
Last Name:CONIGLIO
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LANG
Other - Last Name:CONIGLIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSED, CCC-SLP
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:OAK HALL
Mailing Address - State:VA
Mailing Address - Zip Code:23416-0100
Mailing Address - Country:US
Mailing Address - Phone:757-824-3360
Mailing Address - Fax:
Practice Address - Street 1:8210 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:OAK HALL
Practice Address - State:VA
Practice Address - Zip Code:23416-2114
Practice Address - Country:US
Practice Address - Phone:757-824-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2202007697OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS