Provider Demographics
NPI:1134851835
Name:CUNANAN, HEAVEN
Entity type:Individual
Prefix:
First Name:HEAVEN
Middle Name:
Last Name:CUNANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PEDIATRIC THERAPY PARTNERS
Mailing Address - Street 2:4350 VIKING DRIVE, STE. 1
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:131-829-4913
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC THERAPY PARTNERS
Practice Address - Street 2:4350 VIKING DRIVE, STE. 1
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:131-829-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist