Provider Demographics
NPI:1902513898
Name:HEIMBAUGH, MADELLYN N (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADELLYN
Middle Name:N
Last Name:HEIMBAUGH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50115-1549
Mailing Address - Country:US
Mailing Address - Phone:641-332-3810
Mailing Address - Fax:641-332-2417
Practice Address - Street 1:710 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-1549
Practice Address - Country:US
Practice Address - Phone:641-332-3810
Practice Address - Fax:641-332-2417
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist