Provider Demographics
NPI:1629647441
Name:HEITZ, KAYLEE MARIE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MARIE
Last Name:HEITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4101
Mailing Address - Country:US
Mailing Address - Phone:715-843-1058
Mailing Address - Fax:
Practice Address - Street 1:520 N 28TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4101
Practice Address - Country:US
Practice Address - Phone:715-843-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist