Healthcare Provider Details

I. General information

NPI: 1902639180
Provider Name (Legal Business Name): ANNA HEFFELBOWER SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 S RIO GRANDE AVE STE 206
ORLANDO FL
32809-4650
US

IV. Provider business mailing address

2503 S MILLS AVE
ORLANDO FL
32806-4715
US

V. Phone/Fax

Practice location:
  • Phone: 407-280-3776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: