Provider Demographics
NPI:1821127473
Name:MINICK STARKE, HEIDI (MA CCC-SP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MINICK STARKE
Suffix:
Gender:F
Credentials:MA CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 WOODLANDS TRL
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-3000
Mailing Address - Country:US
Mailing Address - Phone:440-729-1603
Mailing Address - Fax:
Practice Address - Street 1:19824 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-4917
Practice Address - Country:US
Practice Address - Phone:216-991-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 2256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist