Provider Demographics
NPI:1033446240
Name:BARON, HEATHER (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:BARON
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 1:21 SANDS LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1112
Mailing Address - Country:US
Mailing Address - Phone:631-926-9855
Mailing Address - Fax:
Practice Address - Street 1:21 SANDS LN
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1112
Practice Address - Country:US
Practice Address - Phone:631-926-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK010335-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY231H00000XOtherNYS LICENSE # 010335-1