Provider Demographics
NPI:1699111435
Name:HEIMRICH, JOAN ANN (SLP/CCC)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ANN
Last Name:HEIMRICH
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PLYMOUTH ALY APT A
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1285
Mailing Address - Country:US
Mailing Address - Phone:201-445-0068
Mailing Address - Fax:
Practice Address - Street 1:849 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3231
Practice Address - Country:US
Practice Address - Phone:201-445-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00137200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist