Provider Demographics
NPI:1962993337
Name:HEINZE, JENNIFER J (BS,SPED)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:HEINZE
Suffix:
Gender:F
Credentials:BS,SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3759 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-9709
Mailing Address - Country:US
Mailing Address - Phone:716-940-5088
Mailing Address - Fax:
Practice Address - Street 1:9812 LOCKPORT RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1114
Practice Address - Country:US
Practice Address - Phone:716-297-1478
Practice Address - Fax:716-205-0044
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2748751OtherNYS LICENSE