Provider Demographics
NPI:1346308277
Name:HERIOT, JESSICA K (LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:K
Last Name:HERIOT
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 HARFORD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047
Mailing Address - Country:US
Mailing Address - Phone:410-877-7207
Mailing Address - Fax:410-877-7224
Practice Address - Street 1:1716 HARFORD RD SUITE 204
Practice Address - Street 2:KILGALEN ASSOCIATES
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047
Practice Address - Country:US
Practice Address - Phone:410-877-7207
Practice Address - Fax:410-877-7224
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD009881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKC83K1OtherBLUE CROSS BLUE SHIELD
MDT460OtherBLUE CHOICE
MD114M025FMedicare ID - Type Unspecified