Healthcare Provider Details

I. General information

NPI: 1396056248
Provider Name (Legal Business Name): JAIMEE HEFFNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 E GALBRAITH RD BLDG A
CINCINNATI OH
45237-1625
US

IV. Provider business mailing address

2120 E GALBRAITH RD BLDG A
CINCINNATI OH
45237-1625
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6622
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: