Healthcare Provider Details

I. General information

NPI: 1093789182
Provider Name (Legal Business Name): BRIDGET HEGEMAN PHD., L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR 116B
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR 116B
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-2074
  • Fax: 612-727-5964
Mailing address:
  • Phone: 612-467-2074
  • Fax: 612-727-5964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4512
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: