Provider Demographics
NPI:1730345273
Name:SORRELLS, HEIDI JOY (AUD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JOY
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JOY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:555 DOCTOR MICHAEL DEBAKEY DR
Mailing Address - Street 2:STE 104
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5700
Mailing Address - Country:US
Mailing Address - Phone:337-436-3277
Mailing Address - Fax:337-439-3051
Practice Address - Street 1:555 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:STE 104
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5700
Practice Address - Country:US
Practice Address - Phone:337-436-3277
Practice Address - Fax:337-436-3277
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5342231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist