Provider Demographics
NPI:1609044049
Name:HEIDBREDER, JENNIE L (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:L
Last Name:HEIDBREDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13395 COUNTY ROAD 3550
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-7113
Mailing Address - Country:US
Mailing Address - Phone:573-465-3603
Mailing Address - Fax:
Practice Address - Street 1:13395 COUNTY ROAD 3550
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-7113
Practice Address - Country:US
Practice Address - Phone:573-465-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004016481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional