Provider Demographics
NPI:1831337302
Name:HEISLER, JENNIFER (MS CCC-SP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:HEISLER
Suffix:
Gender:F
Credentials:MS CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3649
Mailing Address - Country:US
Mailing Address - Phone:701-662-7690
Mailing Address - Fax:701-662-7684
Practice Address - Street 1:801 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3649
Practice Address - Country:US
Practice Address - Phone:701-662-7690
Practice Address - Fax:701-662-7684
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist