Provider Demographics
NPI:1295844835
Name:HERZOG, JEAN FRANCES (MA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:FRANCES
Last Name:HERZOG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W 7TH AVE
Mailing Address - Street 2:SUITE130
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2843
Mailing Address - Country:US
Mailing Address - Phone:509-220-9601
Mailing Address - Fax:509-747-6817
Practice Address - Street 1:701 W 7TH AVE
Practice Address - Street 2:SUITE130
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2843
Practice Address - Country:US
Practice Address - Phone:509-220-9601
Practice Address - Fax:509-747-6817
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003438101YM0800X
WALF00001095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQMXPR0065530OtherMOLINA HEALTHCARE, INC.
CT7035115OtherAETNA BEHAVIORAL HEALTH