Healthcare Provider Details

I. General information

NPI: 1306090139
Provider Name (Legal Business Name): JEANIE HEUGO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 808
FPO AE
09618-0053
US

IV. Provider business mailing address

PSC 808 BOX 53
FPO AE
09618-0053
US

V. Phone/Fax

Practice location:
  • Phone: 11-081-6372
  • Fax: 11-081-6562
Mailing address:
  • Phone: 11-081-6372
  • Fax: 11-081-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4713C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: