Provider Demographics
NPI:1255497327
Name:BACA, HEATHER M (MS,ED,CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:BACA
Suffix:
Gender:F
Credentials:MS,ED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2542
Mailing Address - Country:US
Mailing Address - Phone:719-846-1500
Mailing Address - Fax:719-846-1501
Practice Address - Street 1:441 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2542
Practice Address - Country:US
Practice Address - Phone:719-846-1500
Practice Address - Fax:719-846-1501
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist