Provider Demographics
NPI:1124370358
Name:HEIDENREICH, ELIZABETH ANNE (PSYD LP)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HEIDENREICH
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5200 WILLSON ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424
Mailing Address - Country:US
Mailing Address - Phone:612-208-8087
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:5200 WILLSON ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424
Practice Address - Country:US
Practice Address - Phone:612-208-8087
Practice Address - Fax:651-628-0411
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000836103TC0700X
MNGL0077103TC0700X
MD05232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical