Provider Demographics
NPI:1538301726
Name:HEIDEL, JENNIFER (MED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HEIDEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RIDGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 UFFELMAN DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2975
Mailing Address - Country:US
Mailing Address - Phone:931-206-0976
Mailing Address - Fax:
Practice Address - Street 1:201 UFFELMAN DR
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2975
Practice Address - Country:US
Practice Address - Phone:931-206-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor