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General NPI Number Information
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NPI Number | 1407561848
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Entity Type | Organization
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Legal Business Name | JENNY HEETDERKS, LICENSED PSYCHOLOGIST, INC.
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 595 E COLORADO BLVD STE 610
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City | PASADENA
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State | CA
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Zip | 91101-2015
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Country | US
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Telephone | 626-765-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 WALWORTH AVE
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City | PASADENA
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State | CA
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Zip | 91104-2332
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER HEETDERKS
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Credential | PSYD
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Telephone | 626-765-7668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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