Provider Demographics
NPI:1265003610
Name:WEBSTER, HEIDI JO
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:WEBSTER
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 1:111 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1917
Mailing Address - Country:US
Mailing Address - Phone:320-281-3339
Mailing Address - Fax:320-200-7505
Practice Address - Street 1:111 2ND ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-1917
Practice Address - Country:US
Practice Address - Phone:320-281-3339
Practice Address - Fax:320-200-7505
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist