Healthcare Provider Details

I. General information

NPI: 1083430847
Provider Name (Legal Business Name): HEATHER FLEMING ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 JOHN KING RD
CRESTVIEW FL
32539-8306
US

IV. Provider business mailing address

5345 OLD RIVER RD
BAKER FL
32531-9302
US

V. Phone/Fax

Practice location:
  • Phone: 850-634-6020
  • Fax:
Mailing address:
  • Phone: 303-596-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: