MEDICARE: JEFF A WIENS HEINSOHN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	302212	MN

General Provider Information

NPI Number	:	1518893536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF A WIENS HEINSOHN

Provider Business Mailing Address
First Line	:	520 OSBORNE RD NE
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-236-4510
Fax Number	:	763-236-7370

Provider Business Practice Location Address
First Line	:	520 OSBORNE RD NE
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-236-4510
Fax Number	:	763-236-7370

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

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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Directions to “ JEFF A WIENS HEINSOHN ” Practice Location

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