Provider Demographics
NPI:1649572488
Name:CLEARY, HEATHER SUE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SUE
Last Name:CLEARY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:SUE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:3330 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-5453
Mailing Address - Country:US
Mailing Address - Phone:585-663-4330
Mailing Address - Fax:585-621-0276
Practice Address - Street 1:3330 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-5453
Practice Address - Country:US
Practice Address - Phone:585-663-4330
Practice Address - Fax:585-621-0276
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist