Provider Demographics
NPI:1154870418
Name:WARD, HEATHER (MED)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 INDIAN SCHOOL RD NE
Mailing Address - Street 2:APT 2208
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4770
Mailing Address - Country:US
Mailing Address - Phone:505-866-0185
Mailing Address - Fax:
Practice Address - Street 1:12801 INDIAN SCHOOL RD NE
Practice Address - Street 2:APT 2208
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4770
Practice Address - Country:US
Practice Address - Phone:505-866-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-6089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist