Provider Demographics
NPI:1710043294
Name:HEIDER, JEFFREY F (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:F
Last Name:HEIDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3539
Mailing Address - Country:US
Mailing Address - Phone:406-752-6107
Mailing Address - Fax:406-752-6722
Practice Address - Street 1:955 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3539
Practice Address - Country:US
Practice Address - Phone:406-752-6107
Practice Address - Fax:406-752-6722
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT173103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical