Provider Demographics
NPI:1942469218
Name:UNTIED-LEONARD, HEATHER MARIE (AUD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:UNTIED-LEONARD
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:UNTIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:27406 CASHFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8199
Mailing Address - Country:US
Mailing Address - Phone:813-994-8900
Mailing Address - Fax:855-388-5350
Practice Address - Street 1:27406 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8199
Practice Address - Country:US
Practice Address - Phone:813-994-8900
Practice Address - Fax:855-388-5350
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1300231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6221WMedicare PIN
FLU6221XMedicare PIN