Provider Demographics
NPI:1225642655
Name:HEPPNER, JESSICA FAITH (CPM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAITH
Last Name:HEPPNER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N 108TH PL STE 100
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4253
Mailing Address - Country:US
Mailing Address - Phone:414-231-9640
Mailing Address - Fax:414-226-5078
Practice Address - Street 1:530 N 108TH PL STE 100
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4253
Practice Address - Country:US
Practice Address - Phone:414-231-9640
Practice Address - Fax:414-226-5078
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI291-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife