Provider Demographics
NPI:1568278372
Name:MAZE, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MAZE
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 1:1940 RACETRACK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-1129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:344 PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-1562
Practice Address - Country:US
Practice Address - Phone:417-845-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220391352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant