Healthcare Provider Details

I. General information

NPI: 1437540093
Provider Name (Legal Business Name): MRS. JENNIFER HEIDRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1149
ANGELUS OAKS CA
92305-1149
US

IV. Provider business mailing address

PO BOX 1149
ANGELUS OAKS CA
92305-1149
US

V. Phone/Fax

Practice location:
  • Phone: 909-730-0750
  • Fax:
Mailing address:
  • Phone: 909-730-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17008
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: