Provider Demographics
NPI:1669091047
Name:HEIDELOFF, DEBORAH PHYLLIS (SLP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:PHYLLIS
Last Name:HEIDELOFF
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3044
Mailing Address - Country:US
Mailing Address - Phone:216-838-1550
Mailing Address - Fax:
Practice Address - Street 1:3033
Practice Address - Street 2:CENTRAL AVE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3044
Practice Address - Country:US
Practice Address - Phone:216-838-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty