Provider Demographics
NPI:1114322146
Name:PALAZZO, HEATHER JOHNSON (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JOHNSON
Last Name:PALAZZO
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 1:7109 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-7409
Mailing Address - Country:US
Mailing Address - Phone:985-640-3988
Mailing Address - Fax:
Practice Address - Street 1:7109 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7409
Practice Address - Country:US
Practice Address - Phone:985-640-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22185235Z00000X
LA7270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist