Provider Demographics
NPI:1831478841
Name:DURHAM, HEIDI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3750 E COUNTRY FIELD CIR STE B
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6659
Mailing Address - Country:US
Mailing Address - Phone:907-373-1410
Mailing Address - Fax:907-373-1411
Practice Address - Street 1:3750 E COUNTRY FIELD CIR STE B
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6659
Practice Address - Country:US
Practice Address - Phone:907-373-1410
Practice Address - Fax:907-373-1411
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17785235Z00000X
AK194636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK173505Medicaid