MEDICARE: JENA LEIGH HEDRICK-WALKER LMHC, LPC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	61840	TX
2	101YM0800X	Mental Health Counselor	MH15727	FL

General Provider Information

NPI Number	:	1356062723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENA LEIGH HEDRICK-WALKER LMHC, LPC-S

Provider Business Mailing Address
First Line	:	2257 THE WOODS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-1028
Country	:	US
Telephone Number	:	903-812-0042
Fax Number	:

Provider Business Practice Location Address
First Line	:	2257 THE WOODS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-1028
Country	:	US
Telephone Number	:	903-812-0042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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