Provider Demographics
NPI:1043467970
Name:HEIDA LTD. CO.
Entity Type:Organization
Organization Name:HEIDA LTD. CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST AIDE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEIDA
Authorized Official - Suffix:
Authorized Official - Credentials:BS-SLP
Authorized Official - Phone:208-420-9773
Mailing Address - Street 1:2327 EASTBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7302
Mailing Address - Country:US
Mailing Address - Phone:208-420-9773
Mailing Address - Fax:
Practice Address - Street 1:2327 EASTBROOKE RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7302
Practice Address - Country:US
Practice Address - Phone:208-420-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLPA-12342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty