Provider Demographics
NPI:1558121343
Name:HEINSCH, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HEINSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GOSSELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 DIEDRICH DR
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315-9303
Mailing Address - Country:US
Mailing Address - Phone:734-386-6463
Mailing Address - Fax:
Practice Address - Street 1:1107 HAZELTINE BLVD STE 370
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1009
Practice Address - Country:US
Practice Address - Phone:952-395-1441
Practice Address - Fax:952-395-1442
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional