Healthcare Provider Details

I. General information

NPI: 1093001711
Provider Name (Legal Business Name): HEATHER MARIE HAYWORTH M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15009 CATLIN TILTON RD
DANVILLE IL
61834
US

IV. Provider business mailing address

15009 CATLIN-TILTON RD.
DANVILLE IL
61834
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-8273
  • Fax: 217-443-0217
Mailing address:
  • Phone: 217-443-8273
  • Fax: 217-443-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146010737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: