Provider Demographics
NPI:1003969858
Name:WRIGHT, HEIDI E (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:E
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1427
Mailing Address - Country:US
Mailing Address - Phone:618-978-0726
Mailing Address - Fax:
Practice Address - Street 1:634 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3733
Practice Address - Country:US
Practice Address - Phone:618-632-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist