Provider Demographics
NPI:1831567304
Name:HEELAN, MARY ELLEN (MT-BC, NMT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:HEELAN
Suffix:
Gender:F
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GREENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1061
Mailing Address - Country:US
Mailing Address - Phone:630-272-3961
Mailing Address - Fax:
Practice Address - Street 1:13 GREENVIEW RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD HILLS
Practice Address - State:IL
Practice Address - Zip Code:60013-1061
Practice Address - Country:US
Practice Address - Phone:630-272-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist