1083630552 NPI number — MS. HEIDI JOHANNA WEBSTER M.S., CCC-SLP

Table of content: MS. HEIDI JOHANNA WEBSTER M.S., CCC-SLP (NPI 1083630552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083630552 NPI number — MS. HEIDI JOHANNA WEBSTER M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBSTER
Provider First Name:
HEIDI
Provider Middle Name:
JOHANNA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GURNON
Provider Other First Name:
HEIDI
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083630552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 BRIARWOOD HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02822-5031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-533-3698
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 PHILLIPS ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KINGSTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-284-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP00467 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2092 . This is a "EI NHPRC" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 412296 . This is a "EI BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 292177 . This is a "EI BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 411540 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 46001013 . This is a "EI UHP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: ES01788 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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