Healthcare Provider Details

I. General information

NPI: 1881240927
Provider Name (Legal Business Name): ERIKA RAE HEGLUND MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 O LEARY LANE
EAGAN MN
55123-5512
US

IV. Provider business mailing address

3450 O LEARY LANE
EAGAN MN
55123
US

V. Phone/Fax

Practice location:
  • Phone: 651-395-5796
  • Fax:
Mailing address:
  • Phone: 651-395-5796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC02167
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: