1669589461 NPI number — MS. JENNIFER FLORENCE HEARIDGE MA, LMHC

Table of content: MS. JENNIFER FLORENCE HEARIDGE MA, LMHC (NPI 1669589461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669589461 NPI number — MS. JENNIFER FLORENCE HEARIDGE MA, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEARIDGE
Provider First Name:
JENNIFER
Provider Middle Name:
FLORENCE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TIETZ
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
FLORENCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669589461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30706
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98228-2706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-305-3660
Provider Business Mailing Address Fax Number:
360-320-8540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3150 ORLEANS ST BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98226-9997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-305-3660
Provider Business Practice Location Address Fax Number:
360-320-8540
Provider Enumeration Date:
08/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH60159915 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)