Healthcare Provider Details

I. General information

NPI: 1093101818
Provider Name (Legal Business Name): JOANNE ZADRA HEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE ZADRA

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W LAKE ST
MELROSE PARK IL
60160-4039
US

IV. Provider business mailing address

1044 N MARION ST
OAK PARK IL
60302-1373
US

V. Phone/Fax

Practice location:
  • Phone: 773-502-3238
  • Fax:
Mailing address:
  • Phone: 773-502-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8142595
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: