Provider Demographics
NPI:1386070597
Name:THORPE, HEIDI REBECCA (MA)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:REBECCA
Last Name:THORPE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MARYLYNN CT STE 310
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-7337
Mailing Address - Country:US
Mailing Address - Phone:616-723-3895
Mailing Address - Fax:
Practice Address - Street 1:8025 MOORSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4073
Practice Address - Country:US
Practice Address - Phone:616-723-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist