Provider Demographics
NPI:1952439846
Name:BOSS, HEATHER ANN (MSLPCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:BOSS
Suffix:
Gender:F
Credentials:MSLPCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1305
Mailing Address - Country:US
Mailing Address - Phone:724-846-8255
Mailing Address - Fax:724-647-1232
Practice Address - Street 1:TWO LANDMARK NORTH 20397 ROUTE 19
Practice Address - Street 2:SUITE 30
Practice Address - City:CRANBERRY TWP.
Practice Address - State:PA
Practice Address - Zip Code:16066-6102
Practice Address - Country:US
Practice Address - Phone:855-887-7332
Practice Address - Fax:866-343-1410
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010778653Medicaid