Provider Demographics
NPI:1275972580
Name:HEINEMANN, KENDRE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:KENDRE
Middle Name:
Last Name:HEINEMANN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 ZIEBER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-2636
Mailing Address - Country:US
Mailing Address - Phone:707-575-3290
Mailing Address - Fax:
Practice Address - Street 1:3808 ZIEBER RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-2636
Practice Address - Country:US
Practice Address - Phone:707-575-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist