MEDICARE: HEIDI M OSBORN CF-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
1	235Z00000X	Speech-Language Pathologist	3010154	WI

General Provider Information

NPI Number	:	1639345259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI M OSBORN CF-SLP

Provider Business Mailing Address
First Line	:	3553 N OAKLAND AVE APT 413
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2752
Country	:	US
Telephone Number	:	248-444-7992
Fax Number	:

Provider Business Practice Location Address
First Line	:	3553 N OAKLAND AVE APT 413
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2752
Country	:	US
Telephone Number	:	248-444-7992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2008
Last Update Date	:	05/03/2008

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Directions to “ HEIDI M OSBORN CF-SLP” Practice Location

Language	Start Address	Practice Location

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