Provider Demographics
NPI:1710017959
Name:MINTZER, HEIDI MARIE (MS CCC-SLP, MED)
Entity Type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:MARIE
Last Name:MINTZER
Suffix:
Gender:F
Credentials:MS CCC-SLP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 OLD FIELD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8303
Mailing Address - Country:US
Mailing Address - Phone:570-759-9944
Mailing Address - Fax:
Practice Address - Street 1:121 OLD FIELD DR
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8303
Practice Address - Country:US
Practice Address - Phone:570-759-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006437L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist