Provider Demographics
NPI:1194067421
Name:HECKENDORN, JENNIFER TRINA (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TRINA
Last Name:HECKENDORN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COLLINGWOOD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3813
Mailing Address - Country:US
Mailing Address - Phone:734-274-0536
Mailing Address - Fax:734-527-6184
Practice Address - Street 1:210 COLLINGWOOD ST STE 120
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3813
Practice Address - Country:US
Practice Address - Phone:734-274-0536
Practice Address - Fax:734-527-6184
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010893231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7969001OtherMEDICARE IDENTIFICATION NUMBER