Provider Demographics
NPI:1851887038
Name:BECKER, HEIDI ANN
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:BECKER
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 1:621 MONTGOMERY LN
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-9618
Mailing Address - Country:US
Mailing Address - Phone:360-531-0021
Mailing Address - Fax:
Practice Address - Street 1:216 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3200
Practice Address - Country:US
Practice Address - Phone:360-565-3741
Practice Address - Fax:360-417-5301
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist