Provider Demographics
NPI:1740748011
Name:DEAN, HEATHER L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:DEAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7146
Mailing Address - Country:US
Mailing Address - Phone:417-838-6148
Mailing Address - Fax:
Practice Address - Street 1:54 MEDICAL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:MO
Practice Address - Zip Code:65656-8386
Practice Address - Country:US
Practice Address - Phone:417-357-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist