Provider Demographics
NPI:1861794463
Name:HIGGINSON, JEANA (LPN)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:HIGGINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 NORTH 400 WEST
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-2131
Mailing Address - Country:US
Mailing Address - Phone:435-283-8400
Mailing Address - Fax:
Practice Address - Street 1:944 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1004
Practice Address - Country:US
Practice Address - Phone:435-623-1456
Practice Address - Fax:435-623-1127
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7160170-3101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health