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NPI Code Detail

MEDICARE: NICOLE VICTORIA HEINTZ M.C.D., CCC-SLP

MEDICARE: NICOLE VICTORIA HEINTZ M.C.D., CCC-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 Pathologist103393TX
2235Z00000XSpeech-Language Pathologist146011867IL

General Provider Information

NPI Number : 1417189556
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE VICTORIA HEINTZ M.C.D., CCC-SLP
Provider Business Mailing Address
First Line : 3755 N RACINE AVE
Second Line : 2E
City : CHICAGO
State : IL
Zip : 60613-4261
Country : US
Telephone Number : 985-981-9801
Fax Number : 985-981-9801
Provider Business Practice Location Address
First Line : 1957 W DICKENS AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-3934
Country : US
Telephone Number : 773-789-9640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2009
Last Update Date : 09/26/2013

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Directions to “ NICOLE VICTORIA HEINTZ M.C.D., CCC-SLP” Practice Location

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