Provider Demographics
NPI:1073212049
Name:HEFNER, JALEN
Entity Type:Individual
Prefix:
First Name:JALEN
Middle Name:
Last Name:HEFNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PARK CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-1929
Mailing Address - Country:US
Mailing Address - Phone:681-588-0550
Mailing Address - Fax:
Practice Address - Street 1:110 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-1929
Practice Address - Country:US
Practice Address - Phone:681-588-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst