Healthcare Provider Details

I. General information

NPI: 1922189703
Provider Name (Legal Business Name): NORMA J HEYDON-WRATHER MHS,CCC,SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 THAYER CTR
OAKLAND MD
21550-1116
US

IV. Provider business mailing address

1606 FREDERICK ST
CUMBERLAND MD
21502-1036
US

V. Phone/Fax

Practice location:
  • Phone: 301-334-1863
  • Fax:
Mailing address:
  • Phone: 301-722-6073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number03475
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: