Basic Information
| Provider Information | |||||||||
| NPI: | 1568673291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRULE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SPL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 W WINNEBAGO ST | ||||||||
| Address2: | |||||||||
| City: | WINNEBAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610888584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153352352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611036921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159656745 | ||||||||
| FaxNumber: | 8159689563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146.006239 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.