Provider Demographics
NPI:1285087635
Name:BIRDWELL, HEATHER
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:BIRDWELL
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 1:604 OAK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3070
Mailing Address - Country:US
Mailing Address - Phone:940-549-3200
Mailing Address - Fax:940-549-3203
Practice Address - Street 1:604 OAK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3070
Practice Address - Country:US
Practice Address - Phone:940-549-3200
Practice Address - Fax:940-549-3203
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80695237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist