Provider Demographics
NPI:1174764930
Name:MCRAE, HEIDI JANE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JANE
Last Name:MCRAE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GROVE CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-4808
Mailing Address - Country:US
Mailing Address - Phone:412-780-4147
Mailing Address - Fax:
Practice Address - Street 1:1018 S WATER AVE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3958
Practice Address - Country:US
Practice Address - Phone:412-780-4147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009395235Z00000X
TN0000003608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1174764930Medicaid