Provider Demographics
NPI:1316047954
Name:BROWN, HEATHER NICOLE (SLP)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:504 N HEWITT DR
Practice Address - Street 2:STE 3 AND 4
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3172
Practice Address - Country:US
Practice Address - Phone:254-399-8255
Practice Address - Fax:254-235-3408
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87545TOtherBLUE CROSS BLUE SHIELD