Provider Demographics
NPI:1033320692
Name:ALLEN, HEIDI KATHLEEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:KATHLEEN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:KATHLEEN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:135 NOTO DR
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1477
Mailing Address - Country:US
Mailing Address - Phone:315-363-8288
Mailing Address - Fax:315-363-8814
Practice Address - Street 1:601 SHERRILL RD
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1461
Practice Address - Country:US
Practice Address - Phone:315-363-8288
Practice Address - Fax:315-363-8814
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011180-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02292611Medicaid