Provider Demographics
NPI:1447629498
Name:KETCHMARK, HEIDI (MA/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:KETCHMARK
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 1:2303 N 97TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5609
Mailing Address - Country:US
Mailing Address - Phone:402-392-7310
Mailing Address - Fax:
Practice Address - Street 1:2303 N 97TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5609
Practice Address - Country:US
Practice Address - Phone:402-392-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist