Provider Demographics
NPI:1700444890
Name:CORRIVEAU, HEIDELISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEIDELISE
Middle Name:
Last Name:CORRIVEAU
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21A SHEPARD ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1747
Mailing Address - Country:US
Mailing Address - Phone:802-233-6564
Mailing Address - Fax:
Practice Address - Street 1:21A SHEPARD ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1747
Practice Address - Country:US
Practice Address - Phone:802-233-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8055194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist