1295844835 NPI number — JEAN FRANCES HERZOG M.A.

Table of content: (NPI 1598130015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295844835 NPI number — JEAN FRANCES HERZOG M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERZOG
Provider First Name:
JEAN
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295844835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 W 7TH AVE
Provider Second Line Business Mailing Address:
SUITE130
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-220-9601
Provider Business Mailing Address Fax Number:
509-747-6817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W 7TH AVE
Provider Second Line Business Practice Location Address:
SUITE130
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-220-9601
Provider Business Practice Location Address Fax Number:
509-747-6817
Provider Enumeration Date:
08/29/2006

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:  LH00003438 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: LF00001095 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: QMXPR0065530 . This is a "MOLINA HEALTHCARE, INC." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7035115 . This is a "AETNA BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".