Provider Demographics
NPI:1407126287
Name:GOURLEY, HEATHER LINDA (MS, CCC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LINDA
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LINDA
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 N MEDICAL DR
Mailing Address - Street 2:SOM1R73
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-2885
Mailing Address - Fax:801-585-6234
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2885
Practice Address - Fax:801-585-6234
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7770080-4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist