MEDICARE: MS. HEIDI L CLOWER MS/CCC-A

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	231H00000X	Audiologist	2314	SC

General Provider Information

NPI Number	:	1558667329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEIDI L CLOWER MS/CCC-A

Provider Business Mailing Address
First Line	:	1805 CONGRESSIONAL BLVD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5185
Country	:	US
Telephone Number	:	843-832-3375
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 ISLAND PARK DR
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7559
Country	:	US
Telephone Number	:	843-971-4199
Fax Number	:	843-971-4292

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

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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