Provider Demographics
NPI:1295550960
Name:DOUD, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:EWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2198 NE STEPHENS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1410
Mailing Address - Country:US
Mailing Address - Phone:541-900-1418
Mailing Address - Fax:541-900-1419
Practice Address - Street 1:2198 NE STEPHENS ST STE 101
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1410
Practice Address - Country:US
Practice Address - Phone:541-900-1418
Practice Address - Fax:541-900-1419
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist