Healthcare Provider Details

I. General information

NPI: 1174968796
Provider Name (Legal Business Name): MISS HEATHER HANKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SAINT JOHN ST
MONTICELLO NY
12701-2118
US

IV. Provider business mailing address

5 WOODMERE CIR
GOSHEN NY
10924-2052
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-4020
  • Fax:
Mailing address:
  • Phone: 914-329-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number023671-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: