Provider Demographics
NPI:1740561166
Name:DUMMER, HEIDI LEIGH (LICSW, OTR/L)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LEIGH
Last Name:DUMMER
Suffix:
Gender:F
Credentials:LICSW, OTR/L
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LEIGH
Other - Last Name:DRYFHOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7250 FRANCE AVE S
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4305
Mailing Address - Country:US
Mailing Address - Phone:952-285-2840
Mailing Address - Fax:952-285-2830
Practice Address - Street 1:7250 FRANCE AVE S
Practice Address - Street 2:SUITE 305
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4305
Practice Address - Country:US
Practice Address - Phone:952-285-2840
Practice Address - Fax:952-285-2830
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0170641041C0700X
MN212141041C0700X
MN104613225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical