Healthcare Provider Details

I. General information

NPI: 1689018376
Provider Name (Legal Business Name): ELIZABETH MARIE HEUERMANN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 WASHINGTON SQ
WASHINGTON IL
61571-2657
US

IV. Provider business mailing address

928 BIRCHWOOD DR
WASHINGTON IL
61571-1601
US

V. Phone/Fax

Practice location:
  • Phone: 309-444-7129
  • Fax:
Mailing address:
  • Phone: 309-657-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146007327
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: