Provider Demographics
NPI:1972979029
Name:HEITZ, DOREEN (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:HEITZ
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 KERRI LN
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68784-6040
Mailing Address - Country:US
Mailing Address - Phone:402-369-4472
Mailing Address - Fax:
Practice Address - Street 1:104 KERRI LN
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:NE
Practice Address - Zip Code:68784-6040
Practice Address - Country:US
Practice Address - Phone:402-369-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12030400 .235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist