Provider Demographics
NPI:1538545900
Name:BLAKLEY, HEATHER LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:BLAKLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:HORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1957 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5329
Mailing Address - Country:US
Mailing Address - Phone:540-907-3174
Mailing Address - Fax:
Practice Address - Street 1:651 RIVER WALK PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-6819
Practice Address - Country:US
Practice Address - Phone:757-401-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005532235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist