MEDICARE: HECKENDORN CONSULTATION AND THERAPY, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1467883587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HECKENDORN CONSULTATION AND THERAPY, PLLC

Provider Business Mailing Address
First Line	:	220 COLLINGWOOD ST STE 140
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-3842
Country	:	US
Telephone Number	:	734-274-0536
Fax Number	:	734-527-6184

Provider Business Practice Location Address
First Line	:	220 COLLINGWOOD ST STE 140
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-3842
Country	:	US
Telephone Number	:	734-274-0536
Fax Number	:	734-527-6184

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER TRINA HECKENDORN
Credential	:
Telephone Number	:	734-274-0536

Provider Enumeration Date	:	11/30/2013
Last Update Date	:	02/22/2019

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