| Nicole Heffron, Llc | |
|
889 Grand Ave Suite 202 Saint Paul MN 55105-3008 | |
| (651) 224-1541 | |
| (651) 224-3501 |
| Full Name | Nicole Heffron, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 889 Grand Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Nicole Englund Heffron (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 6512241541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Heffron, Llc 889 Grand Ave Suite 202 Saint Paul MN 55105-3008 Ph: (651) 224-1541 | Nicole Heffron, Llc 889 Grand Ave Suite 202 Saint Paul MN 55105-3008 Ph: (651) 224-1541 |
| NPI Number | 1639307622 |
|---|---|
| Provider Enumeration Date | 06/29/2009 |
| Last Update Date | 06/29/2009 |
| Medicare PECOS PAC ID | 7719038777 |
|---|---|
| Medicare Enrollment ID | O20090702000269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639307622 | NPI | - | NPPES |
| 572G1EN | Other | MN | BLUE CROSS BLUE SHEILD |
| 148445100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP 4508 (Minnesota) | Primary |
| Provider Name | Nicole E Heffron |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831102839 PECOS PAC ID: 9638134927 Enrollment ID: I20041129000535 |
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