Provider Demographics
NPI:1396775490
Name:GILLUM, HEATHER L (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:GILLUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 41042
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204
Mailing Address - Country:US
Mailing Address - Phone:615-473-7596
Mailing Address - Fax:203-837-4993
Practice Address - Street 1:1304 BEECHWOOD AVE.
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-473-7596
Practice Address - Fax:203-837-4993
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist