Provider Demographics
NPI:1194985010
Name:HACKNEY, HEATHER L (AUD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 NE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5952
Mailing Address - Country:US
Mailing Address - Phone:772-334-2022
Mailing Address - Fax:772-334-6757
Practice Address - Street 1:2340 NE DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-5952
Practice Address - Country:US
Practice Address - Phone:772-334-2022
Practice Address - Fax:772-334-6757
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY403231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist