Heidi Nicklas, MS.CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SL008708 Issued in PA

Practice address

2873 State St
Ridgway, PA 15853-7625

Phone

(814) 834-4109

NPI assigned

Jan 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1285770222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2873 STATE ST",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158537625",
            "telephone_number": "814-834-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2873 STATE ST",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158537625",
            "telephone_number": "814-834-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLAS",
        "first_name": "HEIDI",
        "credential": "MS.CCCSLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL005715L",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL008708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toni A Mosebarger, RN
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• Nelson Behavioral Center, Inc.
• Timothy Joseph Newell
• Office of Human Services, Inc.
• Vikram Singh Panwar, M.D
• Mallory Lynn Park, MSN, CRNP, FNP-C
• Hridayesh K Pathak, M.D.
• Gregory Regis Petrosky, PT

• Speech-Language Pathologist in Ridgway, PA
• Providers in Ridgway, PA by specialty
• Speech-Language Pathologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.