Individual
HEIDI CORNWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 EAGLE AVE, WASHINGTON, IL 61571-1111
(309) 444-3943
Mailing address
2357 HOLLANDS GROVE RD, WASHINGTON, IL 61571-9625
(309) 444-3943
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146005352
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146005352
IDFPR
IL
Enumeration date
08/30/2017
Last updated
08/30/2017
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