Provider Demographics
NPI:1639851363
Name:HEO, JIYOON
Entity Type:Individual
Prefix:
First Name:JIYOON
Middle Name:
Last Name:HEO
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 1:1350 N GREENVILLE AVE APT 4305
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2976
Mailing Address - Country:US
Mailing Address - Phone:931-217-0503
Mailing Address - Fax:
Practice Address - Street 1:1350 N GREENVILLE AVE APT 4305
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2976
Practice Address - Country:US
Practice Address - Phone:931-217-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician