=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730389974
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE ELLEN HEAVEN-HOYLE MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2007
-----------------------------------------------------
Last Update Date | 07/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 ARMSTRONG ROAD
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-223-5077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10482 BELL RD
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48815-9613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6801089263
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------