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General NPI Number Information
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NPI Number | 1932180288
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Entity Type | Individual
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Provider Name | CHRISTOPHER P HEISTAND SLP
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Gender | Male
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 4510 INTELCO LOOP SE STE. B
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City | LACEY
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State | WA
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Zip | 98503-6004
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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 | 1401 MARVIN RD NE 307 #266
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City | LACEY
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State | WA
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Zip | 98516-5749
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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 |
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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 |
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License Number State | WA
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