Provider Demographics
NPI:1912362542
Name:SPAKE, HEATHER PERRY (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:PERRY
Last Name:SPAKE
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 BRIARCLIFF RD NE APT C22
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4067
Mailing Address - Country:US
Mailing Address - Phone:706-506-6545
Mailing Address - Fax:
Practice Address - Street 1:4961 BUFORD HWY STE 200
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3536
Practice Address - Country:US
Practice Address - Phone:404-575-4000
Practice Address - Fax:678-279-7370
Is Sole Proprietor?:No
Enumeration Date:2015-12-26
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist