Provider Demographics
NPI:1699170548
Name:HEAGERTY, AMELIA KARLL (SLP)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:KARLL
Last Name:HEAGERTY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 SW 317TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2136
Mailing Address - Country:US
Mailing Address - Phone:206-948-4526
Mailing Address - Fax:
Practice Address - Street 1:4103 SW 317TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2136
Practice Address - Country:US
Practice Address - Phone:206-948-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60436993235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist