Healthcare Provider Details

I. General information

NPI: 1609542885
Provider Name (Legal Business Name): EMILY ANN HEUCK CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 N LAKE SHORE DR
CHICAGO IL
60657-2883
US

IV. Provider business mailing address

3420 N LAKE SHORE DR APT 3HI
CHICAGO IL
60657-2871
US

V. Phone/Fax

Practice location:
  • Phone: 224-392-6175
  • Fax:
Mailing address:
  • Phone: 224-392-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242006561
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: