Individual
HEATHER WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 NATURE WALK PKWY, SUITE 101, ST AUGUSTINE, FL 32092-5073
(904) 230-7761
(904) 230-7763
Mailing address
111 NATURE WALK PKWY, SUITE 101, ST AUGUSTINE, FL 32092-5073
(904) 230-7761
(904) 230-7763
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA9324
FL
Other
Enumeration date
02/05/2008
Last updated
02/05/2008
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