Provider Demographics
NPI:1598976797
Name:PETERS, HEIDI BROOKS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:BROOKS
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 DECKER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16875-9012
Mailing Address - Country:US
Mailing Address - Phone:814-364-2458
Mailing Address - Fax:
Practice Address - Street 1:915 BENNER PIKE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7395
Practice Address - Country:US
Practice Address - Phone:814-231-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist