Healthcare Provider Details

I. General information

NPI: 1831102839
Provider Name (Legal Business Name): NICOLE ENGLUND HEFFRON NICOLE HEFFRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE LYNN ENGLUND PH.D.

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 4TH ST SE STE 216
MINNEAPOLIS MN
55414-1069
US

IV. Provider business mailing address

630 3RD AVE SE
MINNEAPOLIS MN
55414-1604
US

V. Phone/Fax

Practice location:
  • Phone: 651-224-1541
  • Fax:
Mailing address:
  • Phone: 612-688-3602
  • Fax: 855-538-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4508
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: