Provider Demographics
NPI:1679870992
Name:HEILICSER, CHERYL M (CCC-SLP, BCBA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:HEILICSER
Suffix:
Gender:F
Credentials:CCC-SLP, BCBA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:M
Other - Last Name:BEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:651 PHEASANT TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-8849
Mailing Address - Country:US
Mailing Address - Phone:630-584-6902
Mailing Address - Fax:
Practice Address - Street 1:651 PHEASANT TRL
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-8849
Practice Address - Country:US
Practice Address - Phone:630-584-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-10-7712103K00000X
IL12087067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist