Provider Demographics
NPI:1215026133
Name:HEIDENREICH, LAURA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:HEIDENREICH
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 1:1705 COLLEGE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3917
Mailing Address - Country:US
Mailing Address - Phone:803-777-2630
Mailing Address - Fax:803-777-2630
Practice Address - Street 1:1705 COLLEGE ST STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3917
Practice Address - Country:US
Practice Address - Phone:803-777-2630
Practice Address - Fax:803-777-2630
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist