Provider Demographics
NPI:1730499013
Name:HERATY, NADINE BROZ (MACCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:BROZ
Last Name:HERATY
Suffix:
Gender:F
Credentials:MACCC-SLP/L
Other - Prefix:MISS
Other - First Name:NADINE
Other - Middle Name:MARI
Other - Last Name:BROZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP/L
Mailing Address - Street 1:1763 FLAGSTONE LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8651
Mailing Address - Country:US
Mailing Address - Phone:630-898-0755
Mailing Address - Fax:
Practice Address - Street 1:226 STATE ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1864
Practice Address - Country:US
Practice Address - Phone:630-587-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist