Provider Demographics
NPI:1265738264
Name:BLEDSOE, HEATHER K (CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 QUARTER HORSE LN
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-9004
Mailing Address - Country:US
Mailing Address - Phone:970-901-7861
Mailing Address - Fax:866-793-2739
Practice Address - Street 1:101 N UNCOMPAHGRE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3767
Practice Address - Country:US
Practice Address - Phone:970-901-7861
Practice Address - Fax:866-793-2739
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist