MEDICARE: JESSICA ROSE HEANEY

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	106H00000X	Marriage & Family Therapist	154593	CA
2	106H00000X	Marriage & Family Therapist	132253	CA

General Provider Information

NPI Number	:	1700498078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ROSE HEANEY

Provider Business Mailing Address
First Line	:	8945 GOLF LINKS RD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-4124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 WIKIUP DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1375
Country	:	US
Telephone Number	:	510-317-1444
Fax Number	:

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

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	12/24/2025

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