Provider Demographics
NPI:1437485190
Name:HEIMERL, DARLENE (MA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:HEIMERL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 TWELVE OAKS CENTER DR STE 734
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4450
Mailing Address - Country:US
Mailing Address - Phone:952-258-0668
Mailing Address - Fax:612-235-3384
Practice Address - Street 1:700 TWELVE OAKS CENTER DR STE 734
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4450
Practice Address - Country:US
Practice Address - Phone:952-258-0668
Practice Address - Fax:612-235-3384
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1597103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist