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General NPI Number Information
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NPI Number | 1790879963
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Entity Type | Individual
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Provider Name | HEATHER CARGILL L.P.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1620 GREENVIEW DR SW
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City | ROCHESTER
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State | MN
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Zip | 55902-4319
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Country | US
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Telephone | 507-289-2089
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 HIGHWAY 13 E STE. 101
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City | BURNSVILLE
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State | MN
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Zip | 55337-6865
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Country | US
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Telephone | 952-895-9200
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Fax | 952-895-1946
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4477
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License Number State | MN
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