Healthcare Provider Details

I. General information

NPI: 1295048064
Provider Name (Legal Business Name): LAURA A HEYDEN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PACIFIC ST
MONTEREY CA
93940-2815
US

IV. Provider business mailing address

343 LARKIN ST APT 3
MONTEREY CA
93940-2357
US

V. Phone/Fax

Practice location:
  • Phone: 831-645-1200
  • Fax:
Mailing address:
  • Phone: 619-948-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: