Provider Demographics
NPI:1154511905
Name:HEGLUND, COLIN MICHAEL (MA, LPP)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:MICHAEL
Last Name:HEGLUND
Suffix:
Gender:M
Credentials:MA, LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 15TH ST NW
Mailing Address - Street 2:PO BOX 744
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8755
Mailing Address - Country:US
Mailing Address - Phone:218-751-6553
Mailing Address - Fax:218-751-1846
Practice Address - Street 1:1741 15TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-8755
Practice Address - Country:US
Practice Address - Phone:218-751-6553
Practice Address - Fax:218-751-1846
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPP196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health