Healthcare Provider Details

I. General information

NPI: 1225968506
Provider Name (Legal Business Name): SARA JANE HEESCHEN CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 POLK ST
SLINGER WI
53086-9234
US

IV. Provider business mailing address

207 POLK ST
SLINGER WI
53086-9234
US

V. Phone/Fax

Practice location:
  • Phone: 262-644-9615
  • Fax: 262-644-7514
Mailing address:
  • Phone: 262-644-9615
  • Fax: 262-644-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: