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General NPI Number Information
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NPI Number | 1205740487
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Entity Type | Individual
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Provider Name | PAMELA S HEINEMANN CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 1245 72ND AVE
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City | KENOSHA
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State | WI
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Zip | 53144-7211
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Country | US
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Telephone | 262-359-3297
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 29TH AVE
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City | KENOSHA
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State | WI
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Zip | 53140-4845
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Country | US
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Telephone | 219-484-6493
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | WI
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