=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356834428
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER GLENN MACLEOD LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2018
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6133 11TH AVE S
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55417-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-324-7183
-----------------------------------------------------
Fax | 612-445-8255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6133 11TH AVE S
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55417-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-324-7183
-----------------------------------------------------
Fax | 612-445-8255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3857C-S
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 11145
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------