Healthcare Provider Details

I. General information

NPI: 1831487057
Provider Name (Legal Business Name): HEATHER HEILIGMAN PRUDDEN MSW, L.I.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE SUITE 317
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

2525 CHICAGO AVE SUITE 317
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6029
  • Fax: 612-813-6319
Mailing address:
  • Phone: 612-813-6029
  • Fax: 612-813-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18000
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: