Provider Demographics
NPI:1033495825
Name:HEDRICK, JENNIFER WILSON (LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WILSON
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FLAG LAKE PLZ
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6263
Mailing Address - Country:US
Mailing Address - Phone:979-297-4335
Mailing Address - Fax:979-297-4315
Practice Address - Street 1:56 FLAG LAKE PLZ
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6263
Practice Address - Country:US
Practice Address - Phone:979-297-4335
Practice Address - Fax:979-297-4315
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional