MEDICARE: HEATHER BIRD CHW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1467303263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER BIRD CHW

Provider Business Mailing Address
First Line	:	15855 MAIN AVE
Second Line	:
City	:	RED LAKE
State	:	MN
Zip	:	56671
Country	:	US
Telephone Number	:	218-444-2718
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 5TH ST NW STE A2
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-2932
Country	:	US
Telephone Number	:	218-444-2718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ HEATHER BIRD CHW” Practice Location

Language	Start Address	Practice Location

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