Provider Demographics
NPI:1952395816
Name:HEIDECKER, ALAN KEITH (MA CCCA)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:KEITH
Last Name:HEIDECKER
Suffix:
Gender:M
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:STE 2001
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-796-2001
Mailing Address - Fax:713-796-2349
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:STE 2001
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-796-2001
Practice Address - Fax:713-796-2349
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51528231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist