Provider Demographics
NPI:1558695833
Name:BANKS, HEIDI BRUETTING (M ED, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:BRUETTING
Last Name:BANKS
Suffix:
Gender:F
Credentials:M ED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8244
Mailing Address - Country:US
Mailing Address - Phone:850-897-1509
Mailing Address - Fax:
Practice Address - Street 1:200 PARTIN DR N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1244
Practice Address - Country:US
Practice Address - Phone:850-420-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist