Individual
MS. SALLY MINER HEERDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC- SLP
Contact information
Practice address
38 FAIRWAY CIRCLE, NATICK, MA 01760
(978) 333-9653
Mailing address
38 FAIRWAY CIR, NATICK, MA 01760-2562
(978) 333-9653
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
645
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00716605
ASHA CERTIFICATION
MA
01
—
645
SPEECH PATHOLOGY LICENSE
MA
Enumeration date
06/15/2017
Last updated
07/21/2022
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