Provider Demographics
NPI:1043832397
Name:HEIL, SHANNON ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ANNE
Last Name:HEIL
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 1:43 PITCAIRN DR
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1020
Mailing Address - Country:US
Mailing Address - Phone:973-525-6139
Mailing Address - Fax:
Practice Address - Street 1:304 S VAN DIEN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5200
Practice Address - Country:US
Practice Address - Phone:201-445-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00987700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist