Active NPI
Marisue Heffner, MA CCC SLP
- Speech-Language Pathologist
- Statesboro, GA
National Provider Identifier
1790187045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP008690
- Practice address
- 518 Gentilly Rd
Statesboro, GA 30458-5149 - Phone
- (612) 681-7768
- Fax
- (912) 681-7782
- NPI assigned
- Sep 18, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP008690 | GA | Primary |
Addresses
Primary practice location
518 Gentilly Rd
Statesboro, GA 30458-5149
Mailing address
518 Gentilly Rd
Statesboro, GA 30458-5149
Phone (612) 681-7768
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP008690 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410998400000",
"number": "1790187045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "518 GENTILLY RD",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304585149",
"telephone_number": "612-681-7768",
"fax_number": "912-681-7782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "518 GENTILLY RD",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304585149",
"telephone_number": "612-681-7768",
"fax_number": "912-681-7782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEFFNER",
"first_name": "MARISUE",
"credential": "MA CCC SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-18",
"last_updated": "2014-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SP008690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.