Provider Demographics
NPI:1316209158
Name:ESTREMERA, HEIDI DIANE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:DIANE
Last Name:ESTREMERA
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:DIANE
Other - Last Name:WEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:12062 VALLEY VIEW ST STE 137
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1741
Mailing Address - Country:US
Mailing Address - Phone:714-901-1518
Mailing Address - Fax:
Practice Address - Street 1:12062 VALLEY VIEW ST STE 137
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1741
Practice Address - Country:US
Practice Address - Phone:714-901-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 17603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist