Provider Demographics
NPI:1386930295
Name:MIORI, HEATHER (LSP SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MIORI
Suffix:
Gender:F
Credentials:LSP SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 LEARY LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2818
Mailing Address - Country:US
Mailing Address - Phone:361-573-0731
Mailing Address - Fax:361-573-1594
Practice Address - Street 1:1905 LEARY LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2818
Practice Address - Country:US
Practice Address - Phone:361-573-0731
Practice Address - Fax:361-573-1594
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist