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NPI Code Detail

MEDICARE: HEATHER DIBBLE SLP

MEDICARE:   HEATHER  DIBBLE  SLP
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
1235Z00000XSpeech-Language PathologistNJ

General Provider Information

NPI Number : 1205560018
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER DIBBLE SLP
Provider Business Mailing Address
First Line : 116 SUMMIT AVE
Second Line :
City : MONTCLAIR
State : NJ
Zip : 07043-2223
Country : US
Telephone Number : 914-715-8673
Fax Number :
Provider Business Practice Location Address
First Line : 80 CLOVE RD
Second Line :
City : LITTLE FALLS
State : NJ
Zip : 07424-2102
Country : US
Telephone Number : 973-655-7177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2022
Last Update Date : 07/16/2022

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Directions to “ HEATHER DIBBLE SLP” Practice Location

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