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NPI Code Detail

MEDICARE: HEATHER CARGILL L.P.

MEDICARE: HEATHER CARGILL L.P.
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
1103TC0700XClinical PsychologistLP4477MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790879963
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER CARGILL L.P.
Provider Business Mailing Address
First Line : 1601 HIGHWAY 13 E
Second Line : STE. 101
City : BURNSVILLE
State : MN
Zip : 55337-6865
Country : US
Telephone Number : 952-895-9200
Fax Number : 952-895-1946
Provider Business Practice Location Address
First Line : 1620 GREENVIEW DR SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55902-4319
Country : US
Telephone Number : 507-289-2089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 02/11/2025

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