Organization
NICOLE HEFFRON, LLC
Active
Organization
NICOLE HEFFRON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICOLE ENGLUND HEFFRON PH.D. (LICENSED PSYCHOLOGIST)
(651) 224-1541
Entity
Organization
Contact information
Practice address
889 GRAND AVE, SUITE 202, SAINT PAUL, MN 55105-3008
(651) 224-1541
(651) 224-3501
Mailing address
889 GRAND AVE, SUITE 202, SAINT PAUL, MN 55105-3008
(651) 224-1541
(651) 224-3501
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP 4508
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148445100
—
MN
01
—
572G1EN
BLUE CROSS BLUE SHEILD
MN
Enumeration date
06/29/2009
Last updated
06/29/2009
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