Provider Demographics
NPI:1255766275
Name:WALTERS, HEATHER STAPLETON (SLP-CF)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:STAPLETON
Last Name:WALTERS
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 TEAL CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3189
Mailing Address - Country:US
Mailing Address - Phone:404-242-2254
Mailing Address - Fax:
Practice Address - Street 1:78 OPAL ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2848
Practice Address - Country:US
Practice Address - Phone:404-242-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist