Provider Demographics
NPI:1750893947
Name:ISMAY, HEATHER (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:ISMAY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 US HWY 17
Mailing Address - Street 2:STE 500 PMB 1041
Mailing Address - City:RICHMOND HILL,
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:238 BALD EAGLE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3417
Practice Address - Country:US
Practice Address - Phone:850-206-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-29
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27521235Z00000X
UT13838336-4102235Z00000X
FLSA22645235Z00000X
OR18260235Z00000X
GASLP011132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist