MEDICARE: HEATHER L DEAN CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2004003595	MO

General Provider Information

NPI Number	:	1740748011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER L DEAN CCC-SLP

Provider Business Mailing Address
First Line	:	2326 DAVIS DR
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-7146
Country	:	US
Telephone Number	:	417-838-6148
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 MEDICAL SPRINGS RD
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656-8386
Country	:	US
Telephone Number	:	417-357-6377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/06/2019

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Directions to “ HEATHER L DEAN CCC-SLP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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