Healthcare Provider Details

I. General information

NPI: 1801599212
Provider Name (Legal Business Name): HEATHER AMY PENM LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 CENTRAL PKWY STE 260
EAGAN MN
55121-2488
US

IV. Provider business mailing address

1519 CENTRAL PKWY STE 260
EAGAN MN
55121-2488
US

V. Phone/Fax

Practice location:
  • Phone: 651-212-4920
  • Fax:
Mailing address:
  • Phone: 651-212-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3769
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: