MEDICARE: IVY HEIM MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP.16304	OH

General Provider Information

NPI Number	:	1467253096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY HEIM MS

Provider Business Mailing Address
First Line	:	306 NEW ST
Second Line	:
City	:	FAIRPORT HARBOR
State	:	OH
Zip	:	44077-5529
Country	:	US
Telephone Number	:	440-523-1842
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 WARRENSVILLE CENTER RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5288
Country	:	US
Telephone Number	:	216-282-1582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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Directions to “ IVY HEIM MS” Practice Location

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