Provider Demographics
NPI:1750057766
Name:DAVIDSON, HEATHER R (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:R
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:SAMBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4908 242ND ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5643
Mailing Address - Country:US
Mailing Address - Phone:425-501-9071
Mailing Address - Fax:
Practice Address - Street 1:16030 BOTHELL EVERETT HWY STE 140
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1273
Practice Address - Country:US
Practice Address - Phone:425-338-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist