Provider Demographics
NPI:1487905774
Name:KOORS, HEATHER N (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:N
Last Name:KOORS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:N
Other - Last Name:HIRT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:400 E 1100 S
Mailing Address - Street 2:
Mailing Address - City:MILROY
Mailing Address - State:IN
Mailing Address - Zip Code:46156-9666
Mailing Address - Country:US
Mailing Address - Phone:812-614-1760
Mailing Address - Fax:
Practice Address - Street 1:400 E 1100 S
Practice Address - Street 2:
Practice Address - City:MILROY
Practice Address - State:IN
Practice Address - Zip Code:46156-9666
Practice Address - Country:US
Practice Address - Phone:812-614-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005300A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist