Healthcare Provider Details

I. General information

NPI: 1740771104
Provider Name (Legal Business Name): ALEXIS HEIDEMAN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5933 DUNHAM RD
MAPLE HEIGHTS OH
44137-4053
US

IV. Provider business mailing address

5933 DUNHAM RD
MAPLE HEIGHTS OH
44137-4053
US

V. Phone/Fax

Practice location:
  • Phone: 216-438-6010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.15160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: