Provider Demographics
NPI:1831555473
Name:HEIL, JERALYN
Entity type:Individual
Prefix:
First Name:JERALYN
Middle Name:
Last Name:HEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JERALYN
Other - Middle Name:
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 RAILROAD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5055
Mailing Address - Country:US
Mailing Address - Phone:360-676-2164
Mailing Address - Fax:
Practice Address - Street 1:1133 RAILROAD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5055
Practice Address - Country:US
Practice Address - Phone:360-676-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator