Basic Information
Provider Information
NPI: 1649550435
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CONES
FirstName: HEATHER
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: AU.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3350 LA JOLLA VILLAGE DR
Address2: ASPS
City: SAN DIEGO
State: CA
PostalCode: 921610002
CountryCode: US
TelephoneNumber: 8585527564
FaxNumber: 8586426281
Practice Location
Address1: 3350 LA JOLLA VILLAGE DR
Address2: ASPS
City: SAN DIEGO
State: CA
PostalCode: 921610002
CountryCode: US
TelephoneNumber: 8585527564
FaxNumber: 8586426281
Other Information
ProviderEnumerationDate: 08/24/2011
LastUpdateDate: 08/24/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X2796CAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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