Provider Demographics
NPI:1982064911
Name:HULL, HEATHER (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HULL
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 NW VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6062
Mailing Address - Country:US
Mailing Address - Phone:541-378-8622
Mailing Address - Fax:
Practice Address - Street 1:1490 NW VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6062
Practice Address - Country:US
Practice Address - Phone:541-378-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist