1144477340 NPI number — MISS CARLA JOANN HECKMANN M.S., SLP

Table of content: MISS CARLA JOANN HECKMANN M.S., SLP (NPI 1144477340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144477340 NPI number — MISS CARLA JOANN HECKMANN M.S., SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HECKMANN
Provider First Name:
CARLA
Provider Middle Name:
JOANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.S., SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144477340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1989 MADISON ST
Provider Second Line Business Mailing Address:
SUITE 122
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043-5067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-538-3755
Provider Business Mailing Address Fax Number:
931-538-3756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1989 MADISON ST
Provider Second Line Business Practice Location Address:
SUITE 122
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37043-5067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-538-3755
Provider Business Practice Location Address Fax Number:
931-538-3756
Provider Enumeration Date:
08/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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