Provider Demographics
NPI:1871783340
Name:HEINBACH, JENNIFER NOEL (LSCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NOEL
Last Name:HEINBACH
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12408 W 101ST ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-1912
Mailing Address - Country:US
Mailing Address - Phone:913-492-2272
Mailing Address - Fax:913-492-2272
Practice Address - Street 1:12408 W 101ST ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1912
Practice Address - Country:US
Practice Address - Phone:913-492-2272
Practice Address - Fax:913-492-2272
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS36391041C0700X
MO20030069591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical