Provider Demographics
NPI:1326095092
Name:HEIRING, JESSICA OLSON
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:OLSON
Last Name:HEIRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4215
Mailing Address - Country:US
Mailing Address - Phone:763-588-0661
Mailing Address - Fax:763-287-2310
Practice Address - Street 1:4225 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4215
Practice Address - Country:US
Practice Address - Phone:763-588-0661
Practice Address - Fax:763-302-4346
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN436875400Medicaid
MN265049OtherPREFERRED ONE
MN130007652OtherRAILROAD MEDICARE
MNHP13502OtherHEALTHPARTNERS
MN104791C029OtherUCARE
MN22667OtherAMERICA'S PPO
MN0526122OtherMEDICA
MN4D166HEOtherBCBS OF MN
WI31871000Medicaid