Provider Demographics
NPI:1508000555
Name:BLANCHARD, HEATHER F (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:F
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2940
Mailing Address - Country:US
Mailing Address - Phone:229-881-1241
Mailing Address - Fax:229-244-4244
Practice Address - Street 1:1701 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2940
Practice Address - Country:US
Practice Address - Phone:229-881-1241
Practice Address - Fax:229-244-4244
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist