Provider Demographics
NPI:1699814558
Name:CROUTER, HEATHER MARIE (LL)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:CROUTER
Suffix:
Gender:F
Credentials:LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16120 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3937
Mailing Address - Country:US
Mailing Address - Phone:425-747-4004
Mailing Address - Fax:425-747-1069
Practice Address - Street 1:16120 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3937
Practice Address - Country:US
Practice Address - Phone:425-747-4004
Practice Address - Fax:425-747-1069
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8464679Medicaid