Provider Demographics
NPI:1881716488
Name:BECK, HEIDI (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEN ARGYL
Mailing Address - State:PA
Mailing Address - Zip Code:18072
Mailing Address - Country:US
Mailing Address - Phone:610-533-3868
Mailing Address - Fax:610-881-4123
Practice Address - Street 1:450 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PEN ARGYL
Practice Address - State:PA
Practice Address - Zip Code:18072
Practice Address - Country:US
Practice Address - Phone:610-533-3868
Practice Address - Fax:610-881-4123
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL-004221-L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001927797OtherPROMISE