Individual provider Active NPI

Heather Nichole Bearden, M.ED CF-SLP

  • Speech-Language Pathologist
  • Kennesaw, GA
National Provider Identifier
1639854458
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
3105 Creekside Village Dr NW Ste 603604
Kennesaw, GA 30144-2394
Phone
(770) 974-2424
NPI assigned
Jun 19, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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 GA Primary

Addresses

Primary practice location

3105 Creekside Village Dr NW Ste 603604
Kennesaw, GA 30144-2394

Mailing address

2841 Patches CT NW
Kennesaw, GA 30152-5856
Phone (770) 974-2424

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dynamic Therapy Associates, Inc Speech-Language Pathologist PastSince Jun 25, 2023 Accepting new patients

Organizations & group practices 1

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": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1639854458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 PATCHES CT NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301525856",
            "telephone_number": "770-974-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 CREEKSIDE VILLAGE DR NW STE 603604",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442394",
            "telephone_number": "770-974-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEARDEN",
        "first_name": "HEATHER",
        "middle_name": "NICHOLE",
        "name_prefix": "Ms.",
        "credential": "M.ED CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.