Provider Demographics
NPI:1720323777
Name:KRAJICEK, HEIDI RITA (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RITA
Last Name:KRAJICEK
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 1:194 POLO PARK DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-7778
Mailing Address - Country:US
Mailing Address - Phone:425-335-1530
Mailing Address - Fax:
Practice Address - Street 1:2202 123RD AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-9149
Practice Address - Country:US
Practice Address - Phone:425-335-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00004035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist