Provider Demographics
NPI:1124330006
Name:BERCOT, HEATHER RUTH (CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:RUTH
Last Name:BERCOT
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 QUENTIN CIR
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8779
Mailing Address - Country:US
Mailing Address - Phone:717-360-5242
Mailing Address - Fax:
Practice Address - Street 1:121 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8131
Practice Address - Country:US
Practice Address - Phone:717-530-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist