Provider Demographics
NPI:1144605833
Name:DEW, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 JOHN SIMS PKWY E
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2767
Mailing Address - Country:US
Mailing Address - Phone:850-897-3013
Mailing Address - Fax:850-897-0149
Practice Address - Street 1:1069 JOHN SIMS PKWY E
Practice Address - Street 2:SUITE 4
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2767
Practice Address - Country:US
Practice Address - Phone:850-897-3013
Practice Address - Fax:850-897-0149
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist