Provider Demographics
NPI:1992128458
Name:FRIEND, HEIDI (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:FRIEND
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 AIRBORNE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-8969
Mailing Address - Country:US
Mailing Address - Phone:937-382-6921
Mailing Address - Fax:937-383-3171
Practice Address - Street 1:11611 STATE ROUTE 771
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-8601
Practice Address - Country:US
Practice Address - Phone:937-780-2988
Practice Address - Fax:937-780-6900
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist