Provider Demographics
NPI:1174080048
Name:ANDERSON, HEATHER (MA CCC-SLP, CDP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA CCC-SLP, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2929
Mailing Address - Country:US
Mailing Address - Phone:419-482-8647
Mailing Address - Fax:
Practice Address - Street 1:811 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2929
Practice Address - Country:US
Practice Address - Phone:419-482-8647
Practice Address - Fax:734-597-2018
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist