Provider Demographics
NPI:1508513888
Name:JESTIS, HEATHER RACHELLE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RACHELLE
Last Name:JESTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 S STATE HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:SCURRY
Mailing Address - State:TX
Mailing Address - Zip Code:75158-3163
Mailing Address - Country:US
Mailing Address - Phone:972-452-8823
Mailing Address - Fax:972-452-3939
Practice Address - Street 1:10705 S STATE HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:SCURRY
Practice Address - State:TX
Practice Address - Zip Code:75158-3163
Practice Address - Country:US
Practice Address - Phone:972-452-8823
Practice Address - Fax:972-452-3939
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist