Healthcare Provider Details

I. General information

NPI: 1780507673
Provider Name (Legal Business Name): HEATHER MICHELLE LINK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W TOKAY ST
LODI CA
95240-3810
US

IV. Provider business mailing address

1621 BRANDYWINE CT
LODI CA
95240-7401
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-0830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: