Provider Demographics
NPI:1891194924
Name:HEIDTMAN, JESSICA LYNN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:HEIDTMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ZEUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:201 RUBLEIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4060
Mailing Address - Country:US
Mailing Address - Phone:906-233-1236
Mailing Address - Fax:906-233-1235
Practice Address - Street 1:201 RUBLEIN ST STE D
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4060
Practice Address - Country:US
Practice Address - Phone:906-250-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010968541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN21670092Medicare PIN