Provider Demographics
NPI:1033566922
Name:HERNANDEZ, JEFF
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 17TH ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4543
Mailing Address - Country:US
Mailing Address - Phone:307-459-1712
Mailing Address - Fax:
Practice Address - Street 1:109 E 17TH ST
Practice Address - Street 2:SUITE 213
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4543
Practice Address - Country:US
Practice Address - Phone:307-459-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker