Provider Demographics
NPI:1821519760
Name:ROSE, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ROSE
Other - Last Name:KARCHEFSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2972 FOX TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3254
Mailing Address - Country:US
Mailing Address - Phone:775-250-5445
Mailing Address - Fax:
Practice Address - Street 1:1625 E PRATER WAY STE 107
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8963
Practice Address - Country:US
Practice Address - Phone:775-825-4744
Practice Address - Fax:775-351-1644
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist