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Individual
NICOLE HEAVILIN
Active
Individual
NICOLE HEAVILIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
119307
TX
235Z00000X
Speech-Language Pathologist
Primary
2202007831
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194411
ANTHEM
VA
01
—
45084
OPTIMA
VA
05
—
49-7850-1
—
VA
Enumeration date
03/23/2016
Last updated
12/20/2022
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