Basic Information
Provider Information
NPI: 1003294794
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HECKENLIVELY
FirstName: LINDA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: M.S., CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7501 MAY WAY
Address2:  
City: SAN RAMON
State: CA
PostalCode: 945833709
CountryCode: US
TelephoneNumber: 9258290779
FaxNumber: 9258290779
Practice Location
Address1: 320 LENNON LN
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945982419
CountryCode: US
TelephoneNumber: 9259062268
FaxNumber: 9259022255
Other Information
ProviderEnumerationDate: 05/13/2015
LastUpdateDate: 05/13/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X7424CAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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