Provider Demographics
NPI:1427528173
Name:KLEMETSEN, HEATHER NICHOLE (MS, LADC, LPCC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICHOLE
Last Name:KLEMETSEN
Suffix:
Gender:F
Credentials:MS, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5907 TOWN ROAD 238
Mailing Address - Street 2:
Mailing Address - City:LITTLEFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56653-9411
Mailing Address - Country:US
Mailing Address - Phone:218-324-1133
Mailing Address - Fax:
Practice Address - Street 1:900 5TH ST STE 301
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2200
Practice Address - Country:US
Practice Address - Phone:218-285-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305054101YA0400X
MN2715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)