Provider Demographics
NPI:1811352362
Name:WHITE, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:LEIFSON-WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:199 CRYSTAL WATER WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-7668
Mailing Address - Country:US
Mailing Address - Phone:775-530-3928
Mailing Address - Fax:
Practice Address - Street 1:3427 GONI RD
Practice Address - Street 2:STE 104
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-8011
Practice Address - Country:US
Practice Address - Phone:775-687-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist