Provider Demographics
NPI:1093837429
Name:BECKENDORF, HEIDI SUE (ATC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:SUE
Last Name:BECKENDORF
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 ASPEN LAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-7508
Mailing Address - Country:US
Mailing Address - Phone:763-784-2634
Mailing Address - Fax:
Practice Address - Street 1:3939 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1261
Practice Address - Country:US
Practice Address - Phone:763-506-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer