Healthcare Provider Details

I. General information

NPI: 1538808787
Provider Name (Legal Business Name): COURTNEY LEE HEYDORFF M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 09/30/2026
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N HANDY ST
ORANGE CA
92867
US

IV. Provider business mailing address

1401 N HANDY ST
ORANGE CA
92867
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-6178
  • Fax:
Mailing address:
  • Phone: 844-669-7827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: