Provider Demographics
NPI:1326831199
Name:HEFFERNAN, JADE M
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:M
Last Name:HEFFERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 FISHCREEK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1962
Mailing Address - Country:US
Mailing Address - Phone:330-356-4419
Mailing Address - Fax:
Practice Address - Street 1:419 SILVER MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-1913
Practice Address - Country:US
Practice Address - Phone:330-968-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant