=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154667285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASCO SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2012
-----------------------------------------------------
Last Update Date | 01/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 W LEWIS ST
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99301-5472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-543-6703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1215 W LEWIS ST
-----------------------------------------------------
City | PASCO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99301-5472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH THERAPIST
-----------------------------------------------------
Name | CHRISTINA M HEFFNER
-----------------------------------------------------
Credential | MS CCC-SLP
-----------------------------------------------------
Telephone | 509-543-6748
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | LL60419856
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------