Provider Demographics
NPI:1972695161
Name:LANDECKER, HELLER SUE (LICSW)
Entity type:Individual
Prefix:MS
First Name:HELLER
Middle Name:SUE
Last Name:LANDECKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GROVELAND TER
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1154
Mailing Address - Country:US
Mailing Address - Phone:612-798-1686
Mailing Address - Fax:612-343-8112
Practice Address - Street 1:15 GROVELAND TER
Practice Address - Street 2:SUITE 202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1154
Practice Address - Country:US
Practice Address - Phone:612-798-1686
Practice Address - Fax:612-343-8112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN085871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN106605OtherUCARE
MN7G548LAOtherBLUE CROSS/BLUE SHIELD
MN6181114OtherMEDICA