Provider Demographics
NPI:1265716641
Name:ZINN, HEIDI R (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:R
Last Name:ZINN
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 1:25090 CRIMSON LASSO DR
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7614
Mailing Address - Country:US
Mailing Address - Phone:951-907-1716
Mailing Address - Fax:951-698-2296
Practice Address - Street 1:23905 CLINTON KEITH RD # 114-367
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7897
Practice Address - Country:US
Practice Address - Phone:951-907-1716
Practice Address - Fax:951-698-2296
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist