Provider Demographics
NPI:1073804050
Name:HEBERER, PAULA DENISE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:DENISE
Last Name:HEBERER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 STATE HIGHWAY 109
Mailing Address - Street 2:APT 3
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2351
Mailing Address - Country:US
Mailing Address - Phone:618-498-3593
Mailing Address - Fax:
Practice Address - Street 1:702 STATE HIGHWAY 109
Practice Address - Street 2:APT 3
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2351
Practice Address - Country:US
Practice Address - Phone:618-498-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110499235Z00000X
IL146.005011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist