Provider Demographics
NPI:1306090139
Name:HEUGO, JEANIE (MSW)
Entity type:Individual
Prefix:MS
First Name:JEANIE
Middle Name:
Last Name:HEUGO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 808 BOX 53
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09618-0053
Mailing Address - Country:US
Mailing Address - Phone:011-081-6372
Mailing Address - Fax:011-081-6562
Practice Address - Street 1:PSC 808
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09618-0053
Practice Address - Country:US
Practice Address - Phone:011-081-6372
Practice Address - Fax:011-081-6562
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4713C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical