Provider Demographics
NPI:1831228253
Name:HEUTMAKER, JENNY
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:HEUTMAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:8156 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2109
Mailing Address - Country:US
Mailing Address - Phone:206-715-2200
Mailing Address - Fax:
Practice Address - Street 1:2025 112TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2943
Practice Address - Country:US
Practice Address - Phone:425-458-4788
Practice Address - Fax:425-462-8894
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000044561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPE3806Medicare UPIN