Provider Demographics
NPI:1770558892
Name:HEATON, JEANNE ALBRONDA (JEANNE HEATON, PHD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:ALBRONDA
Last Name:HEATON
Suffix:
Gender:F
Credentials:JEANNE HEATON, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1116
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1116
Mailing Address - Country:US
Mailing Address - Phone:740-593-1616
Mailing Address - Fax:
Practice Address - Street 1:3 WEST STIMSON
Practice Address - Street 2:
Practice Address - City:ATHENS,
Practice Address - State:OH
Practice Address - Zip Code:45701-1116
Practice Address - Country:US
Practice Address - Phone:740-707-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2547103TA0400X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0358876Medicaid