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General NPI Number Information
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NPI Number | 1750893947
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Entity Type | Individual
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Provider Name | HEATHER ISMAY M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/29/2017
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 238 BALD EAGLE DR
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3417
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Country | US
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Telephone | 850-206-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 US HWY 17 STE 500 PMB 1041
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City | RICHMOND HILL
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State | GA
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Zip | 31324
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Country | US
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Telephone |
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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 | 27521
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 13838336-4102
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA22645
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 18260
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP011132
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License Number State | GA
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