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General NPI Number Information
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NPI Number | 1114027075
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Entity Type | Individual
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Provider Name | MARILYN JOAN HECKELBECK H.I.S.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 614 WASHINGTON ST SUITE 101
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-2251
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Country | US
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Telephone | 660-646-7110
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Fax | 660-646-7110
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Provider Business Mailing Address
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Address Line | 614 WASHINGTON ST SUITE 101
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-2251
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Country | US
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Telephone | 660-646-7110
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Fax | 660-646-7110
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 0725
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License Number State | MO
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