Healthcare Provider Details

I. General information

NPI: 1134051576
Provider Name (Legal Business Name): HEATHER CECCARELLI M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 ADAMS AVE
SCRANTON PA
18509-1598
US

IV. Provider business mailing address

2073 W LAPLUME RD
FACTORYVILLE PA
18419-1915
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-6299
  • Fax:
Mailing address:
  • Phone: 570-212-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL012049
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: