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General NPI Number Information
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NPI Number | 1205976701
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Entity Type | Individual
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Provider Name | HEATHER MARIE DEWYZE MS.CF
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 06/13/2017
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Provider Practice Location Address
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Address Line | 500 7TH AVE S BOX 7700
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4820
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Country | US
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Telephone | 727-767-6725
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Fax |
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Provider Business Mailing Address
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Address Line | 835 20TH AVENUE NORTH
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City | ST PETERSBURG
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State | FL
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Zip | 33704
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Country | US
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Telephone | 727-767-4141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA9188
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License Number State | FL
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