Provider Demographics
NPI:1679827315
Name:HEFLIN, DERRICK
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:HEFLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 FAWN HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1879
Mailing Address - Country:US
Mailing Address - Phone:309-573-3093
Mailing Address - Fax:
Practice Address - Street 1:5401 N KNOXVILLE AVE STE 116
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5011
Practice Address - Country:US
Practice Address - Phone:309-282-0887
Practice Address - Fax:309-282-0947
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3034237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist