Basic Information
| Provider Information | |||||||||
| NPI: | 1639236144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MA, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14598 BRIDLE RIDGE TRL NE | ||||||||
| Address2: | |||||||||
| City: | PRIOR LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553721159 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9201 E BLOOMINGTON FWY STE Q | ||||||||
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| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554203413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528847353 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1336 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.