Provider Demographics
NPI:1083630552
Name:WEBSTER, HEIDI JOHANNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:JOHANNA
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:J
Other - Last Name:GURNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:20 BRIARWOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-5031
Mailing Address - Country:US
Mailing Address - Phone:401-533-3698
Mailing Address - Fax:
Practice Address - Street 1:320 PHILLIPS ST STE 103
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-284-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2092OtherEI NHPRC
RI412296OtherEI BLUE CHIP
RI292177OtherEI BLUE CROSS
RI411540OtherBLUE CHIP
RI46001013OtherEI UHP
RIES01788Medicaid