Heather Gustafson
Individual provider Active NPI Speech-Language Pathologist · Kewanee, IL
NPI 1144748237 · NPPES record last updated Dec 3, 2020
Key facts
- NPI
- 1144748237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 146009642 (IL)
- Practice address
- 1401 Lake St
Kewanee, IL 61443-1649 - Phone
- (309) 852-2449
- NPI assigned
- Sep 8, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146009642 | IL | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146009642 | IL | Yes |
Addresses
Primary practice location
1401 Lake St
Kewanee, IL 61443-1649
Mailing address
208 N Vernon St
Princeton, IL 61356-1715
Other providers in Kewanee, IL
- Philip Gambon
- Dennis J Gerleman
- Mary Kathleen Gordon
- Shamaila B Gorsi
- Brian D Grondin
- Hammond Henry Dist Hospital
- Riley Hansen
- Nicole Lynn Harmon
- Linda Ann Harris-Teach
- Kerry Howard Head
All providers in Kewanee, IL · Speech-Language Pathologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.