Provider Demographics
NPI:1679324909
Name:SPIKES, HEIDI ALLYN
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ALLYN
Last Name:SPIKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 ELAM HARPER CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:WRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31798-4748
Mailing Address - Country:US
Mailing Address - Phone:912-850-7397
Mailing Address - Fax:
Practice Address - Street 1:515 PETERSON AVE S STE B
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5244
Practice Address - Country:US
Practice Address - Phone:912-501-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist