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General NPI Number Information
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NPI Number | 1992128458
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Entity Type | Individual
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Provider Name | HEIDI FRIEND M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 11611 STATE ROUTE 771
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City | LEESBURG
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State | OH
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Zip | 45135-8601
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Country | US
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Telephone | 937-780-2988
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Fax | 937-780-6900
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Provider Business Mailing Address
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Address Line | 3321 AIRBORNE RD
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City | WILMINGTON
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State | OH
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Zip | 45177-8969
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Country | US
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Telephone | 937-382-6921
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Fax | 937-383-3171
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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 | SP.10542
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License Number State | OH
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