Provider Demographics
NPI:1194811679
Name:BOOTH, HEATHER MARIE (MS,CCC-A)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MS,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 THE STRAND #3
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254
Mailing Address - Country:US
Mailing Address - Phone:310-798-3675
Mailing Address - Fax:
Practice Address - Street 1:50 NORTH LA CIENEGA BLVD
Practice Address - Street 2:SUITE #201
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-860-9646
Practice Address - Fax:310-854-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1629231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAUD1629Medicare ID - Type UnspecifiedMEDICARE