Provider Demographics
NPI:1669695680
Name:DOOLEY, HEATHER MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 KEYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9108
Mailing Address - Country:US
Mailing Address - Phone:812-481-2849
Mailing Address - Fax:
Practice Address - Street 1:313 POPLAR ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-2423
Practice Address - Country:US
Practice Address - Phone:812-295-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003822A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist