Provider Demographics
NPI:1336431428
Name:JACKMAN, HEIDI S (BA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:S
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 ROBERTA LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6802
Mailing Address - Country:US
Mailing Address - Phone:775-331-6252
Mailing Address - Fax:775-331-6250
Practice Address - Street 1:895 ROBERTA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6802
Practice Address - Country:US
Practice Address - Phone:775-331-6252
Practice Address - Fax:775-331-6250
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0000086388103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst