Provider Demographics
NPI:1952556763
Name:HEYWARD, OPAL ELIZABETH (MS, SLP, TSHH)
Entity type:Individual
Prefix:MRS
First Name:OPAL
Middle Name:ELIZABETH
Last Name:HEYWARD
Suffix:
Gender:F
Credentials:MS, SLP, TSHH
Other - Prefix:
Other - First Name:OPAL
Other - Middle Name:ELIZABETH
Other - Last Name:LAING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2213 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6301
Mailing Address - Country:US
Mailing Address - Phone:718-683-3775
Mailing Address - Fax:
Practice Address - Street 1:2213 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6301
Practice Address - Country:US
Practice Address - Phone:718-683-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNO NUMBER235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist