Provider Demographics
NPI:1356800593
Name:KAUFMAN, HEATHER RENEE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 BANGOR DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1122
Mailing Address - Country:US
Mailing Address - Phone:301-503-4578
Mailing Address - Fax:
Practice Address - Street 1:850 HUNGERFORD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1718
Practice Address - Country:US
Practice Address - Phone:301-650-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist