Healthcare Provider Details

I. General information

NPI: 1881036788
Provider Name (Legal Business Name): CHRISTINA JEAN HEIBERGER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 3RD AVE SE
ABERDEEN SD
57401-5420
US

IV. Provider business mailing address

905 17TH AVE SW
ABERDEEN SD
57401-5639
US

V. Phone/Fax

Practice location:
  • Phone: 605-626-4380
  • Fax: 605-626-4391
Mailing address:
  • Phone: 605-626-1187
  • Fax: 605-626-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12123521
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: