Provider Demographics
NPI:1497180764
Name:HEIM, ALLISON MARIE (MA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:HEIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:377 E CHAPMAN AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5055
Mailing Address - Country:US
Mailing Address - Phone:714-528-4405
Mailing Address - Fax:
Practice Address - Street 1:377 E CHAPMAN AVE
Practice Address - Street 2:STE 220
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5055
Practice Address - Country:US
Practice Address - Phone:714-528-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP21062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist