Provider Demographics
NPI:1063988640
Name:HEAVILON, MARGARET ELLEN (MA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:HEAVILON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:HEAVILON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:69 DEANE RD
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3482
Mailing Address - Country:US
Mailing Address - Phone:434-481-3521
Mailing Address - Fax:434-481-3628
Practice Address - Street 1:69 DEANE RD
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3482
Practice Address - Country:US
Practice Address - Phone:434-481-3521
Practice Address - Fax:434-481-3628
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist