MEDICARE: KAREN F HEEGAARD M.A. L.P.

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	103T00000X	Psychologist	LP3419	MN

General Provider Information

NPI Number	:	1386770998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN F HEEGAARD M.A. L.P.

Provider Business Mailing Address
First Line	:	3912 PLEASANT AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1529
Country	:	US
Telephone Number	:	612-810-7349
Fax Number	:	612-824-8438

Provider Business Practice Location Address
First Line	:	1133 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2629
Country	:	US
Telephone Number	:	651-641-0177
Fax Number	:	641-641-8635

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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