Provider Demographics
NPI:1629032420
Name:JUNG, LAUREL HEDDEN (MA)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:HEDDEN
Last Name:JUNG
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 1:4005 W 65TH ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1720
Mailing Address - Country:US
Mailing Address - Phone:952-922-5554
Mailing Address - Fax:952-922-5554
Practice Address - Street 1:4005 W 65TH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1720
Practice Address - Country:US
Practice Address - Phone:952-922-5554
Practice Address - Fax:952-922-5554
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN286103T00000X
MN73471041C0700X
MN165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist