Provider Demographics
NPI:1942726997
Name:WISNIEWSKI, HEATHER (SLP-CF)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 S FEDERAL HWY APT E
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-8817
Mailing Address - Country:US
Mailing Address - Phone:561-512-7852
Mailing Address - Fax:
Practice Address - Street 1:12792 FOREST HILL BLVD UNIT 30
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4748
Practice Address - Country:US
Practice Address - Phone:561-753-4998
Practice Address - Fax:561-753-4998
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program