Provider Demographics
NPI:1285813865
Name:DAWES, HEIDI J (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:DAWES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:J
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:5337 MOONGATE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1243
Mailing Address - Country:US
Mailing Address - Phone:352-610-4632
Mailing Address - Fax:
Practice Address - Street 1:5337 MOONGATE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1243
Practice Address - Country:US
Practice Address - Phone:352-610-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5199235Z00000X
252Y00000X
FL9959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency