=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629111687
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER RANEY M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37571 S HERRON RD
-----------------------------------------------------
City | MARANA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-204-5362
-----------------------------------------------------
Fax | 520-682-3721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37571 S HERRON RD
-----------------------------------------------------
City | MARANA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-204-5362
-----------------------------------------------------
Fax | 520-682-3721
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP1783
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------