Healthcare Provider Details

I. General information

NPI: 1578967733
Provider Name (Legal Business Name): HEATHER ALLDREDGE L-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 TRULY PLZ STE A
CLEVELAND TX
77327-4889
US

IV. Provider business mailing address

142 TRULY PLZ STE A
CLEVELAND TX
77327-4889
US

V. Phone/Fax

Practice location:
  • Phone: 281-659-2949
  • Fax: 281-659-1509
Mailing address:
  • Phone: 281-659-2949
  • Fax: 281-659-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80499
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: