Provider Demographics
NPI:1912040510
Name:HESTRUP, JAMIE LINN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LINN
Last Name:HESTRUP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 N 78TH ST
Mailing Address - Street 2:APT 2141
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6161
Mailing Address - Country:US
Mailing Address - Phone:480-544-5465
Mailing Address - Fax:
Practice Address - Street 1:5802 E. DOVE VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262
Practice Address - Country:US
Practice Address - Phone:480-575-2457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-12217104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker