Provider Demographics
NPI:1205190956
Name:HEERKENS, JENNA LEIGH (MSED)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEIGH
Last Name:HEERKENS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MISS
Other - First Name:JENNA
Other - Middle Name:LEIGH
Other - Last Name:EMPEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:6 N MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1524
Mailing Address - Country:US
Mailing Address - Phone:585-377-6590
Mailing Address - Fax:
Practice Address - Street 1:6 N MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1524
Practice Address - Country:US
Practice Address - Phone:585-377-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist