Provider Demographics
NPI:1326237751
Name:HESLI, DEBORAH A (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:HESLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:DAWIDOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 AMES CROSSING RD STE 600
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2519
Mailing Address - Country:US
Mailing Address - Phone:651-774-0011
Mailing Address - Fax:651-774-0606
Practice Address - Street 1:1930 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4708
Practice Address - Country:US
Practice Address - Phone:651-774-0011
Practice Address - Fax:651-774-0606
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN148121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1326237751OtherUBH
MN6C692LEOtherBCBS
MNHP94506OtherHEALTH PARTNERS
MN973126100Medicaid
MNHP94506OtherHEALTH PARTNERS