Provider Demographics
NPI:1740403542
Name:CLARK, HEIDI RINGGENBERG (MAT, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:RINGGENBERG
Last Name:CLARK
Suffix:
Gender:F
Credentials:MAT, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11688 LAKE FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7208
Mailing Address - Country:US
Mailing Address - Phone:317-818-8166
Mailing Address - Fax:
Practice Address - Street 1:11688 LAKE FOREST PKWY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7208
Practice Address - Country:US
Practice Address - Phone:317-818-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002150A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist