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General NPI Number Information
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NPI Number | 1417189556
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Entity Type | Individual
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Provider Name | NICOLE VICTORIA HEINTZ M.C.D., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 1957 W DICKENS AVE
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City | CHICAGO
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State | IL
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Zip | 60614-3934
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Country | US
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Telephone | 773-789-9640
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Fax |
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Provider Business Mailing Address
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Address Line | 3755 N RACINE AVE 2E
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City | CHICAGO
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State | IL
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Zip | 60613-4261
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Country | US
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Telephone | 985-981-9801
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Fax | 985-981-9801
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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 | 103393
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146011867
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License Number State | IL
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