Provider Demographics
NPI:1922253798
Name:DAVIDSON, HEATHER L B (MS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:L B
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 HAWKES TRL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4210
Mailing Address - Country:US
Mailing Address - Phone:585-507-7203
Mailing Address - Fax:
Practice Address - Street 1:175 N WINTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1936
Practice Address - Country:US
Practice Address - Phone:585-697-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018463-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist