Provider Demographics
NPI:1376738757
Name:BURNETT, HEIDI
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:BURNETT
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 1:2360 MONTEBELLO SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6977
Mailing Address - Country:US
Mailing Address - Phone:719-460-8386
Mailing Address - Fax:719-522-0159
Practice Address - Street 1:2835 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1662
Practice Address - Country:US
Practice Address - Phone:719-533-1318
Practice Address - Fax:719-533-1319
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01113646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000176621Medicaid