Healthcare Provider Details

I. General information

NPI: 1154511905
Provider Name (Legal Business Name): COLIN MICHAEL HEGLUND M.A., LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 TECHNOLOGY DR NW
BEMIDJI MN
56601-5118
US

IV. Provider business mailing address

1741 15TH ST NW PO BOX 744
BEMIDJI MN
56601-8755
US

V. Phone/Fax

Practice location:
  • Phone: 218-751-0282
  • Fax: 218-751-0870
Mailing address:
  • Phone: 218-751-6553
  • Fax: 218-751-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP5248
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: