Basic Information
| Provider Information | |||||||||
| NPI: | 1619032950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONIGLIO | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | PATRICE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 OLD POST LN | ||||||||
| Address2: | |||||||||
| City: | SAINT JAMES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117804237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314067012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 BELLE TERRE RD | ||||||||
| Address2: | IN PATIENT SPEECH PATHOLOGY | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314746000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 03/23/2010 | ||||||||
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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 | 012330-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.