Provider Demographics
NPI:1891307476
Name:HEINIGER, AIMEE ROSE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:ROSE
Last Name:HEINIGER
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:ROSE
Other - Last Name:MOCCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CF-SLP
Mailing Address - Street 1:6742 ROLLINGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426
Mailing Address - Country:US
Mailing Address - Phone:248-470-9528
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:2250 28TH ST SW STE 2
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-2306
Practice Address - Country:US
Practice Address - Phone:616-379-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7151000893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7151000893OtherSTATE LICENSE