Provider Demographics
NPI:1396024675
Name:HEZOUCKY, JENNIFER LOUISE (MT-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:HEZOUCKY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:JACOBSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43933-0062
Mailing Address - Country:US
Mailing Address - Phone:740-338-8292
Mailing Address - Fax:
Practice Address - Street 1:49563 O R AND W STATION ST
Practice Address - Street 2:
Practice Address - City:JACOBSBURG
Practice Address - State:OH
Practice Address - Zip Code:43933-9606
Practice Address - Country:US
Practice Address - Phone:740-338-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09246225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist