Individual
MS. HEATHER GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 LAKE ST, KEWANEE, IL 61443-1649
(309) 852-2449
Mailing address
208 N VERNON ST, PRINCETON, IL 61356-1715
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146009642
IL
Other
Enumeration date
09/08/2017
Last updated
12/03/2020
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