Provider Demographics
NPI:1891534996
Name:HEISTER, CAMRYN (SLP)
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:
Last Name:HEISTER
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 1:223 N LIME ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2748
Mailing Address - Country:US
Mailing Address - Phone:717-394-3793
Mailing Address - Fax:717-396-7409
Practice Address - Street 1:223 N LIME ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2748
Practice Address - Country:US
Practice Address - Phone:717-394-3793
Practice Address - Fax:717-396-7409
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL0176752355S0801X, 235Z00000X
GASLP013032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant