Healthcare Provider Details

I. General information

NPI: 1487863874
Provider Name (Legal Business Name): ANNIE LYNNE HEIDERSCHEIT PH.D., MT-BC, FAMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNETTE LYNNE HEIDERSCHEIT PH.D., LMFT

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 HIGHWAY 100 S SUITE 250
ST LOUIS PARK MN
55416-1529
US

IV. Provider business mailing address

1660 HIGHWAY 100 S SUITE 250
ST LOUIS PARK MN
55416-1529
US

V. Phone/Fax

Practice location:
  • Phone: 612-741-1182
  • Fax:
Mailing address:
  • Phone: 612-741-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2301
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: