Provider Demographics
NPI:1801157540
Name:O'NEILL, HEATHER L (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:O'NEILL
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:W6737 KIESLING RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9609
Mailing Address - Country:US
Mailing Address - Phone:920-222-9506
Mailing Address - Fax:
Practice Address - Street 1:W6737 KIESLING RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9609
Practice Address - Country:US
Practice Address - Phone:920-222-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3642-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist