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General NPI Number Information
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NPI Number | 1891965513
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER HEISTAND SLP, INC. PS
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 4531 INTELCO LOOP SE SUITE 3
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City | LACEY
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State | WA
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Zip | 98503-5941
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Country | US
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Telephone | 360-786-1753
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Fax | 360-786-1793
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Provider Business Mailing Address
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Address Line | 4820 YELM HWY SE STE B PMB 210
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City | LACEY
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State | WA
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Zip | 98503-4904
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Country | US
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Telephone | 360-786-1753
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Fax | 360-786-1793
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRISTOPHER P HEISTAND
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Credential | SLP
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Telephone | 360-786-1753
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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 | LL00003377
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License Number State | WA
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