Provider Demographics
NPI:1821355249
Name:WHITTINGTON, HEATHER LYNN
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 S FARM ROAD 241
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8527
Mailing Address - Country:US
Mailing Address - Phone:417-259-6048
Mailing Address - Fax:
Practice Address - Street 1:200 W ODELL STREET
Practice Address - Street 2:S COLLEGE AVENUE AND 200 W ODELL ST
Practice Address - City:MARIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65705
Practice Address - Country:US
Practice Address - Phone:417-258-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012002471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist