Provider Demographics
NPI:1154828069
Name:HEIDRICH, JENNIFER LIANG (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LIANG
Last Name:HEIDRICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LIANG
Other - Last Name:HEMSTREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2261 PHILADELPHIA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1814
Mailing Address - Country:US
Mailing Address - Phone:937-734-4141
Mailing Address - Fax:937-277-7249
Practice Address - Street 1:2261 PHILADELPHIA DR STE 301
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406
Practice Address - Country:US
Practice Address - Phone:937-734-4141
Practice Address - Fax:937-277-7249
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine