Healthcare Provider Details

I. General information

NPI: 1629214747
Provider Name (Legal Business Name): HEATHER LYNN SVOBODA MA LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER SVOBODA MA LP

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CLIFTON AVE
MINNEAPOLIS MN
55403-3218
US

IV. Provider business mailing address

7601 WAYZATA BLVD
ST LOUIS PARK MN
55426-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-223-8898
  • Fax: 612-338-8899
Mailing address:
  • Phone: 763-521-3477
  • Fax: 763-521-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5110
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: