Provider Demographics
NPI:1245723105
Name:HEBERLEIN, KILEY
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:HEBERLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 ELLIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-3155
Mailing Address - Country:US
Mailing Address - Phone:708-341-3981
Mailing Address - Fax:
Practice Address - Street 1:6109 ELLIOT AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-3155
Practice Address - Country:US
Practice Address - Phone:612-208-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN518296235Z00000X
IL146014796235Z00000X
242261235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist