Provider Demographics
NPI:1447269253
Name:SCOTT, HEATHER (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 NW WINDFLOWER TER
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3557
Mailing Address - Country:US
Mailing Address - Phone:772-232-4858
Mailing Address - Fax:772-232-4858
Practice Address - Street 1:533 NW WINDFLOWER TER
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3557
Practice Address - Country:US
Practice Address - Phone:772-232-4858
Practice Address - Fax:772-232-4858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
FLSA6498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019074200Medicaid