Provider Demographics
NPI:1619260544
Name:HEIDT, SHERYL LEE (MA CCC-SLP 6590)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:LEE
Last Name:HEIDT
Suffix:
Gender:F
Credentials:MA CCC-SLP 6590
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 STILL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5367
Mailing Address - Country:US
Mailing Address - Phone:661-726-4978
Mailing Address - Fax:
Practice Address - Street 1:44722 FERN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3111
Practice Address - Country:US
Practice Address - Phone:661-726-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist