Provider Demographics
NPI:1134702392
Name:HENDRICKSON, HEATHER DIANE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DIANE
Last Name:HENDRICKSON
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 1:3081 COPPERTREE CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2362
Mailing Address - Country:US
Mailing Address - Phone:209-658-1579
Mailing Address - Fax:
Practice Address - Street 1:5079 HIGHWAY 140
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-2434
Practice Address - Country:US
Practice Address - Phone:209-742-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker