Provider Demographics
NPI:1376960088
Name:MEBANE, HEATHER (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MEBANE
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 1:3200 TROUP HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8364
Mailing Address - Country:US
Mailing Address - Phone:903-509-3742
Mailing Address - Fax:903-509-3744
Practice Address - Street 1:3200 TROUP HWY STE 120
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8364
Practice Address - Country:US
Practice Address - Phone:903-509-3742
Practice Address - Fax:903-509-3744
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist