Provider Demographics
NPI:1457383176
Name:SKEEN, HEATHER HEIM (M ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:HEIM
Last Name:SKEEN
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 MANTARIO DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5215
Mailing Address - Country:US
Mailing Address - Phone:704-948-9071
Mailing Address - Fax:
Practice Address - Street 1:5846 MANTARIO DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5215
Practice Address - Country:US
Practice Address - Phone:704-948-9071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01143954OtherASHA CERTIFICATION NUMBER
NC4641OtherSTATE LICENSE NUMBER