Provider Demographics
NPI:1356674832
Name:SEGERSTEN, HEATHER NOEL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NOEL
Last Name:SEGERSTEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 S WAKEFIELD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3084
Mailing Address - Country:US
Mailing Address - Phone:703-685-1070
Mailing Address - Fax:703-685-0151
Practice Address - Street 1:939 S WAKEFIELD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3084
Practice Address - Country:US
Practice Address - Phone:703-685-1070
Practice Address - Fax:703-685-0151
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist