Provider Demographics
NPI:1932666146
Name:HEITMAN, JESSICA KAY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAY
Last Name:HEITMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12016 CHARWICK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1705
Mailing Address - Country:US
Mailing Address - Phone:314-650-6811
Mailing Address - Fax:
Practice Address - Street 1:12016 CHARWICK DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1705
Practice Address - Country:US
Practice Address - Phone:314-730-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14184459-35011041C0700X
MO20150286291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical