MEDICARE: MS. JULIE HEISLER

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	SLP 0216	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619057692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE HEISLER

Provider Business Mailing Address
First Line	:	4721 E GATEWOOD RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-6153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4721 E GATEWOOD RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-6153
Country	:	US
Telephone Number	:	480-502-0211
Fax Number	:	480-502-4489

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/09/2007

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Directions to “ MS. JULIE HEISLER ” Practice Location

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