MEDICARE: JENNIFER KAY HEINRICHS CPD,LS,CPR CERTIFIED

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	374J00000X	Doula	374J00000X	GA

General Provider Information

NPI Number	:	1447586193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KAY HEINRICHS CPD,LS,CPR CERTIFIED

Provider Business Mailing Address
First Line	:	2605 LITTLE JOHN CIR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2882
Country	:	US
Telephone Number	:	770-780-2997
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 LITTLE JOHN CIR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2882
Country	:	US
Telephone Number	:	770-780-2997
Fax Number	:

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

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	10/29/2009

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