Provider Demographics
NPI:1942415013
Name:RICH, HEATHER LINN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LINN
Last Name:RICH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4486 S CAMERON LN
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4372
Mailing Address - Country:US
Mailing Address - Phone:208-356-9108
Mailing Address - Fax:208-356-9108
Practice Address - Street 1:4486 S CAMERON LN
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-4372
Practice Address - Country:US
Practice Address - Phone:208-356-9108
Practice Address - Fax:208-356-9108
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP1363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist