Provider Demographics
NPI:1194556696
Name:HEATHCOCK, SHIRLEY CAROLINE
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:CAROLINE
Last Name:HEATHCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 E KIMBROUGH ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4420
Mailing Address - Country:US
Mailing Address - Phone:972-882-7700
Mailing Address - Fax:
Practice Address - Street 1:3500 PIONEER RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75180-2404
Practice Address - Country:US
Practice Address - Phone:972-882-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist