MEDICARE: HEIDI WHITE

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	SP331	NV

General Provider Information

NPI Number	:	1811352362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI WHITE

Provider Business Mailing Address
First Line	:	199 CRYSTAL WATER WAY
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-7668
Country	:	US
Telephone Number	:	775-530-3928
Fax Number	:

Provider Business Practice Location Address
First Line	:	3427 GONI RD
Second Line	:	STE 104
City	:	CARSON CITY
State	:	NV
Zip	:	89706-8011
Country	:	US
Telephone Number	:	775-687-0101
Fax Number	:

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

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	12/29/2015

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Directions to “ HEIDI WHITE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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