Provider Demographics
NPI:1881860039
Name:MARTIN, HEATHER NOELLE (MS CCCSLP)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:NOELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:N
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCCSLP
Mailing Address - Street 1:128 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9778
Mailing Address - Country:US
Mailing Address - Phone:610-743-3793
Mailing Address - Fax:
Practice Address - Street 1:99 BETHANY RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522
Practice Address - Country:US
Practice Address - Phone:610-743-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist