Provider Demographics
NPI:1205239761
Name:SCISM, HEATHER (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SCISM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17228 LANCASTER HWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2078
Mailing Address - Country:US
Mailing Address - Phone:704-307-9541
Mailing Address - Fax:704-540-1197
Practice Address - Street 1:17228 LANCASTER HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2078
Practice Address - Country:US
Practice Address - Phone:704-307-9541
Practice Address - Fax:704-540-1197
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9859235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist