Provider Demographics
NPI:1760967459
Name:KENT, HEATHER HENDERSON (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:HENDERSON
Last Name:KENT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 SELMA AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5841
Mailing Address - Country:US
Mailing Address - Phone:850-323-1701
Mailing Address - Fax:
Practice Address - Street 1:4419 TRAM RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-2559
Practice Address - Country:US
Practice Address - Phone:850-747-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17271235Z00000X
FLSZ8864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist