Provider Demographics
NPI:1215060017
Name:SHERIDAN, HEIDI MICHELLE (AU)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:MICHELLE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:AU
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MICHELLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1160 WALLACE RD NW STE 150
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3116
Mailing Address - Country:US
Mailing Address - Phone:503-331-3060
Mailing Address - Fax:
Practice Address - Street 1:1160 WALLACE RD NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3116
Practice Address - Country:US
Practice Address - Phone:503-331-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61094500231H00000X
OR30791231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500668711Medicaid
ORK162033Medicare UPIN