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6425 Nicollet Ave Richfield MN 55423-1668 | |
| (612) 861-1675 | |
| (612) 861-3446 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 6425 Nicollet Ave, Richfield, Minnesota |
| Authorized Official Name and Position | Cadi Thyne (DIRECTOR REVENUE OPERATIONS) |
| Authorized Official Contact | 6127591633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6425 Nicollet Ave Richfield MN 55423-1668 Ph: (612) 861-1675 | 6425 Nicollet Ave Richfield MN 55423-1668 Ph: (612) 861-1675 |
| NPI Number | 1386728228 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 05/10/2024 |
| Certification Date | 05/10/2024 |
| Medicare PECOS PAC ID | 0840197828 |
|---|---|
| Medicare Enrollment ID | O20031217000719 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386728228 | NPI | - | NPPES |
| 875055600 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Minnesota) | Primary |
| Provider Name | Julie A Heckathorne |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1285830182 PECOS PAC ID: 9537211925 Enrollment ID: I20090715000750 |
| Provider Name | Nicole J Slavik |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609210251 PECOS PAC ID: 8426291410 Enrollment ID: I20130823000048 |
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