Healthcare Provider Details

I. General information

NPI: 1346968062
Provider Name (Legal Business Name): JENNIFER MEGAN HEYMAN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7190 S STATE ROUTE 44
WILLIAMSPORT PA
17702-8230
US

IV. Provider business mailing address

800 ASH ST
WATSONTOWN PA
17777-1018
US

V. Phone/Fax

Practice location:
  • Phone: 570-745-2400
  • Fax:
Mailing address:
  • Phone: 570-768-6318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLO14657
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: