Provider Demographics
NPI:1972603975
Name:BROWN, HEIDI (SLP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:MINNEWAUKAN
Mailing Address - State:ND
Mailing Address - Zip Code:58351-0156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 14TH AVE NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2808
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:763-689-5558
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20577OtherBLUE CROSS BLUE SHIELD
MN4600398OtherMEDICA
ND51543Medicaid
MN068R6BROtherBLUE CROSS BLUE SHIELD
MN068R6BROtherBLUE CROSS BLUE SHIELD