Provider Demographics
NPI:1174830186
Name:SIGNORILE, HEATHER MARIE (CCC-SLP, TSLD)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:SIGNORILE
Suffix:
Gender:F
Credentials:CCC-SLP, TSLD
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:HAGESTAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP, TSLD
Mailing Address - Street 1:7002 RIDGE BLVD
Mailing Address - Street 2:APT. B9
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7002 RIDGE BLVD
Practice Address - Street 2:APT. B9
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1257
Practice Address - Country:US
Practice Address - Phone:718-753-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0188141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist