Provider Demographics
NPI:1023538857
Name:MAZZOLA, HEATHER MARGARET (AUD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARGARET
Last Name:MAZZOLA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 INDICA DR APT 422
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7179
Mailing Address - Country:US
Mailing Address - Phone:904-728-1166
Mailing Address - Fax:
Practice Address - Street 1:7800 LAKE BOONE TRAIL
Practice Address - Street 2:100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-787-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12444231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist