Provider Demographics
NPI:1104948025
Name:WARD, HEATHER LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:WARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:SONNER-WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 ANDOVER LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8541
Mailing Address - Country:US
Mailing Address - Phone:803-547-1375
Mailing Address - Fax:
Practice Address - Street 1:1767 BENTGRASS LN
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-8537
Practice Address - Country:US
Practice Address - Phone:803-547-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist