Healthcare Provider Details

I. General information

NPI: 1912922832
Provider Name (Legal Business Name): HEATHER A. RHODES M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S POKEGAMA AVE STE 160
GRAND RAPIDS MN
55744-4296
US

IV. Provider business mailing address

PO BOX 607
COLERAINE MN
55722-0607
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-0887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLP3017
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3017
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP3017
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP3017
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: