Healthcare Provider Details

I. General information

NPI: 1831258003
Provider Name (Legal Business Name): HEIDI LYNN MORTENSON MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11709 JEWELL CT NE
BLAINE MN
55449-5876
US

IV. Provider business mailing address

21000 ROGERS DR SUITE 200
ROGERS MN
55374-4652
US

V. Phone/Fax

Practice location:
  • Phone: 651-247-6833
  • Fax: --
Mailing address:
  • Phone: 763-291-5505
  • Fax: 763-657-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1894
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: