Provider Demographics
NPI:1356913933
Name:BARRANCO, HEATHER WATSON
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:WATSON
Last Name:BARRANCO
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 1:19 LAKE ELOISE LN
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-2821
Mailing Address - Country:US
Mailing Address - Phone:863-224-0362
Mailing Address - Fax:
Practice Address - Street 1:130 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4166
Practice Address - Country:US
Practice Address - Phone:863-679-6560
Practice Address - Fax:863-679-6565
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI38692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant