Provider Demographics
NPI:1457813396
Name:BLACK, HEIDI JOLENE (AAS, QMHS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JOLENE
Last Name:BLACK
Suffix:
Gender:F
Credentials:AAS, QMHS
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JOLENE
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2845 BELL ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1720
Mailing Address - Country:US
Mailing Address - Phone:740-454-9766
Mailing Address - Fax:740-588-6452
Practice Address - Street 1:2500 JOHN GLENN HWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9028
Practice Address - Country:US
Practice Address - Phone:740-439-4428
Practice Address - Fax:740-439-3389
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator