MEDICARE: HEIDI VERENA JACHE MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	35. 055135	OH

General Provider Information

NPI Number	:	1811068505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI VERENA JACHE MD

Provider Business Mailing Address
First Line	:	1 OHIO UNIVERSITY, HUDSON HEALTH CENTER 3RD FLOOR
Second Line	:	OHIO UNIVERSITY COUNSELING AND PYSCHOLOGICAL SERVICES
City	:	ATHENS
State	:	OH
Zip	:	45701-2979
Country	:	US
Telephone Number	:	740-593-1616
Fax Number	:	740-593-0091

Provider Business Practice Location Address
First Line	:	1 OHIO UNIVERSITY, HUDSON HEALTH CENTER 3RD FLOOR
Second Line	:	OHIO UNIVERSITY COUNSELING AND PYSCHOLOGICAL SERVICES
City	:	ATHENS
State	:	OH
Zip	:	45701-2979
Country	:	US
Telephone Number	:	740-593-1616
Fax Number	:	740-593-0091

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	03/10/2014

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