MEDICARE: JAIMEE HEFFNER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6622	OH

General Provider Information

NPI Number	:	1396056248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIMEE HEFFNER PH.D.

Provider Business Mailing Address
First Line	:	2120 E GALBRAITH RD BLDG A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-1625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 E GALBRAITH RD BLDG A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-1625
Country	:	US
Telephone Number	:	513-558-7187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	06/25/2010

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