Provider Demographics
NPI:1891571295
Name:HETTESHEIMER, ANNALISSE (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ANNALISSE
Middle Name:
Last Name:HETTESHEIMER
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 CROSS CREEK RD APT A
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-4133
Mailing Address - Country:US
Mailing Address - Phone:513-550-3021
Mailing Address - Fax:
Practice Address - Street 1:810 W SOUTH 4TH ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3324
Practice Address - Country:US
Practice Address - Phone:864-886-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.8564.SPIN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist