MEDICARE: MS. KATIE E. HECKMAN LMFT

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	106H00000X	Marriage & Family Therapist	1338	MN

General Provider Information

NPI Number	:	1437225323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATIE E. HECKMAN LMFT

Provider Business Mailing Address
First Line	:	1875 NORTHWESTERN AVE S
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-7534
Country	:	US
Telephone Number	:	651-439-4840
Fax Number	:	651-641-8635

Provider Business Practice Location Address
First Line	:	1129 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2629
Country	:	US
Telephone Number	:	651-641-0177
Fax Number	:	651-641-8635

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	05/20/2020

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