Provider Demographics
NPI:1477934479
Name:HEIDEMANN, KACEY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:HEIDEMANN
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 1:9433 BEE CAVE RD
Mailing Address - Street 2:BLDG3, STE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-6135
Mailing Address - Country:US
Mailing Address - Phone:512-306-8007
Mailing Address - Fax:
Practice Address - Street 1:9433 BEE CAVE RD
Practice Address - Street 2:BLDG3, STE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-6135
Practice Address - Country:US
Practice Address - Phone:512-306-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist