Provider Demographics
NPI:1568673291
Name:BRULE, HEATHER (SPL)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:BRULE
Suffix:
Gender:F
Credentials:SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W WINNEBAGO ST
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:IL
Mailing Address - Zip Code:61088-8584
Mailing Address - Country:US
Mailing Address - Phone:815-335-2352
Mailing Address - Fax:
Practice Address - Street 1:650 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-6921
Practice Address - Country:US
Practice Address - Phone:815-965-6745
Practice Address - Fax:815-968-9563
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist