Healthcare Provider Details

I. General information

NPI: 1518815232
Provider Name (Legal Business Name): HEIDI ESTREM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 MARYLAND AVE N
CHAMPLIN MN
55316-3349
US

IV. Provider business mailing address

11212 MARYLAND AVE N
CHAMPLIN MN
55316-3349
US

V. Phone/Fax

Practice location:
  • Phone: 952-393-1902
  • Fax:
Mailing address:
  • Phone: 952-393-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21169
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: