Individual provider Active NPI

Laura Marie Heidenreich, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Columbia, SC
National Provider Identifier
1215026133
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
3958 Issued in SC
Practice address
1705 College St Ste 220
Columbia, SC 29201-3917
Phone
(803) 777-2630
Fax
(803) 777-2630
NPI assigned
Oct 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 3958 SC Primary

Addresses

Primary practice location

1705 College St Ste 220
Columbia, SC 29201-3917

Mailing address

1705 College St Ste 220
Columbia, SC 29201-3917
Phone (803) 777-2630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240513003747 SC Practitioner - Qualified Speech Language Pathologist 7810338555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of South Carolina SystemGroup PAC ID 3274582788, 10 clinicians

Practice addresses (Care Compare)

1705 College St
Suite 220
Columbia, SC 29201-3917
Phone (803) 777-2630

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
3958SCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
University of South Carolina System CurrentSince Jan 17, 2024 Accepting new patients
University of South Carolina System Speech-Language Pathologist CurrentSince Jan 17, 2024 Accepting new patients
University of South Carolina Aiken Past Accepting new patients

Locations

1705 College St
Ste 220
Columbia, SC 29201
Phone (803) 777-2614

1705 College St
Columbia, SC 29201

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1215026133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 COLLEGE ST STE 220",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292013917",
            "telephone_number": "803-777-2630",
            "fax_number": "803-777-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 COLLEGE ST STE 220",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292013917",
            "telephone_number": "803-777-2630",
            "fax_number": "803-777-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDENREICH",
        "first_name": "LAURA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "3958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.