Provider Demographics
NPI:1508954538
Name:ELZA, HEATHER ANNETTE (MSCCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANNETTE
Last Name:ELZA
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-6106
Mailing Address - Country:US
Mailing Address - Phone:606-843-6781
Mailing Address - Fax:606-862-0033
Practice Address - Street 1:536 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:EAST BERNSTADT
Practice Address - State:KY
Practice Address - Zip Code:40729-6106
Practice Address - Country:US
Practice Address - Phone:606-843-6781
Practice Address - Fax:606-862-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist