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NPI Code Detail

MEDICARE: KATHERINE ELIZABETH HEENAN M ED

MEDICARE: KATHERINE ELIZABETH HEENAN M ED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1053504993
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE ELIZABETH HEENAN M ED
Provider Business Mailing Address
First Line : 3100 N LAKE SHORE DR
Second Line : APT 804
City : CHICAGO
State : IL
Zip : 60657-4946
Country : US
Telephone Number : 773-633-0995
Fax Number :
Provider Business Practice Location Address
First Line : 4026 W IRVING PARK ROAD
Second Line :
City : CHICAGO
State : IL
Zip : 60641-2925
Country : US
Telephone Number : 773-282-5274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2007
Last Update Date : 09/18/2007

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