Healthcare Provider Details

I. General information

NPI: 1760371611
Provider Name (Legal Business Name): HEATHER SVOBODA MA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HENNEPIN AVE STE 205
MINNEAPOLIS MN
55403-3189
US

IV. Provider business mailing address

1900 HENNEPIN AVE STE 205
MINNEAPOLIS MN
55403-3160
US

V. Phone/Fax

Practice location:
  • Phone: 651-300-6266
  • Fax:
Mailing address:
  • Phone: 651-300-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: HEATHER L SVOBODA
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MA LP
Phone: 651-300-6266