Provider Demographics
NPI:1659771335
Name:HEATH, HEATHER (SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9427
Mailing Address - Country:US
Mailing Address - Phone:910-616-0204
Mailing Address - Fax:
Practice Address - Street 1:124 EAST PARK DR
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-6916
Practice Address - Country:US
Practice Address - Phone:888-258-6905
Practice Address - Fax:888-258-6905
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist