Provider Demographics
NPI:1124162078
Name:GILES, HEATHER
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12023 FIR ST
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64442-8180
Mailing Address - Country:US
Mailing Address - Phone:660-867-5221
Mailing Address - Fax:660-867-5263
Practice Address - Street 1:12023 FIR ST
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64442-8180
Practice Address - Country:US
Practice Address - Phone:660-867-5221
Practice Address - Fax:660-867-5263
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist