Provider Demographics
NPI:1871791400
Name:JAEGER-HEIDEN, ANNE MARIE (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARIE
Last Name:JAEGER-HEIDEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:AJ
Other - Middle Name:
Other - Last Name:JAEGER-HEIDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1918 SUNSET CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1756
Mailing Address - Country:US
Mailing Address - Phone:269-982-4135
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY ST
Practice Address - Street 2:SUITE 7 - T
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-2408
Practice Address - Country:US
Practice Address - Phone:269-637-6929
Practice Address - Fax:269-637-7220
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1974646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional