Provider Demographics
NPI:1639362080
Name:HETER, PAULETTE SUE (MA CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:SUE
Last Name:HETER
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N PINE GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6958
Mailing Address - Country:US
Mailing Address - Phone:316-644-7919
Mailing Address - Fax:
Practice Address - Street 1:415 N LANCASTER CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67230-7808
Practice Address - Country:US
Practice Address - Phone:316-644-7919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist