MEDICARE: HEATHER LYNN HEVENER MA, CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-5375	OH

General Provider Information

NPI Number	:	1134124837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LYNN HEVENER MA, CCC/SLP

Provider Business Mailing Address
First Line	:	6598 COUNTRY RIDGE AVE
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-5555
Country	:	US
Telephone Number	:	330-793-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	6598 COUNTRY RIDGE AVE
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-5555
Country	:	US
Telephone Number	:	330-793-8830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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Directions to “ HEATHER LYNN HEVENER MA, CCC/SLP” Practice Location

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