Provider Demographics
NPI:1831321835
Name:HEINRICH, ANN D (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:D
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 S APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1751
Mailing Address - Country:US
Mailing Address - Phone:920-735-9977
Mailing Address - Fax:920-735-9732
Practice Address - Street 1:3010 S APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1751
Practice Address - Country:US
Practice Address - Phone:920-735-9977
Practice Address - Fax:920-735-9732
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist