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General NPI Number Information
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NPI Number | 1407770795
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Entity Type | Individual
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Provider Name | ELISSA ANN HEERMANN
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Gender | Female
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 2352 N 4TH ST #481
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City | FLAGSTAFF
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State | AZ
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Zip | 86004
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Country | US
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Telephone | 928-226-1563
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Fax |
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Provider Business Mailing Address
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Address Line | 19082 N 85TH LN
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City | PEORIA
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State | AZ
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Zip | 85382-8712
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Country | US
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Telephone | 307-752-6007
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA17727
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License Number State | AZ
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