Provider Demographics
NPI:1326648643
Name:MANGELSEN, HEIDI LOUISE (LICSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LOUISE
Last Name:MANGELSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LOUISE
Other - Last Name:HILGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-1166
Mailing Address - Fax:
Practice Address - Street 1:111 HUNDERTMARK RD STE 220
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1197
Practice Address - Country:US
Practice Address - Phone:952-448-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN254911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical