Provider Demographics
NPI:1013358969
Name:EISENMAN, HEATHER E (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:E
Last Name:EISENMAN
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:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:ESTER
Mailing Address - State:AK
Mailing Address - Zip Code:99725-0507
Mailing Address - Country:US
Mailing Address - Phone:707-364-2013
Mailing Address - Fax:
Practice Address - Street 1:1528 BLUEGRASS DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5635
Practice Address - Country:US
Practice Address - Phone:707-364-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12092554-4102235Z00000X
COSLP.0004132235Z00000X
NVSP-2904235Z00000X
AK335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist