Healthcare Provider Details

I. General information

NPI: 1679390900
Provider Name (Legal Business Name): HEATHERSTONE THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 02/02/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2746 SUPERIOR DR NW STE 350
ROCHESTER MN
55901-8343
US

IV. Provider business mailing address

2746 SUPERIOR DR NW STE 350
ROCHESTER MN
55901-8343
US

V. Phone/Fax

Practice location:
  • Phone: 507-565-0340
  • Fax:
Mailing address:
  • Phone: 507-565-0340
  • Fax: 507-262-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER R HINDAL
Title or Position: THERAPIST
Credential: LICSW
Phone: 507-565-0340