Provider Demographics
NPI:1932261518
Name:GOTTHELF, HEATHER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GOTTHELF
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 1:335 PARKWAY 575 STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3878
Mailing Address - Country:US
Mailing Address - Phone:770-591-5852
Mailing Address - Fax:
Practice Address - Street 1:2408 E UNIVERSITY DR STE 109
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-9404
Practice Address - Country:US
Practice Address - Phone:334-734-5511
Practice Address - Fax:334-734-5512
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL208904Medicaid