MEDICARE: HEATHER MCINTOSH 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		LA

General Provider Information

NPI Number	:	1366702474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MCINTOSH SLP

Provider Business Mailing Address
First Line	:	100 RIDGEWAY DR
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-4932
Country	:	US
Telephone Number	:	318-308-5499
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 LASALLE CIR
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-4732
Country	:	US
Telephone Number	:	318-308-5499
Fax Number	:

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

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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Directions to “ HEATHER MCINTOSH SLP” Practice Location

Language	Start Address	Practice Location

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