Provider Demographics
NPI:1346015617
Name:STROMBERG, HEIDI (MED)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:STROMBERG
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 PILOT KNOB RD STE 190
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1152
Mailing Address - Country:US
Mailing Address - Phone:651-452-1500
Mailing Address - Fax:
Practice Address - Street 1:2520 PILOT KNOB RD STE 190
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1152
Practice Address - Country:US
Practice Address - Phone:651-452-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician