Provider Demographics
NPI:1760513790
Name:VASQUEZ, ANDREA HEEZEN (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:HEEZEN
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 CURRELL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2295
Mailing Address - Country:US
Mailing Address - Phone:651-259-9750
Mailing Address - Fax:651-259-9790
Practice Address - Street 1:7616 CURRELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2295
Practice Address - Country:US
Practice Address - Phone:651-259-9750
Practice Address - Fax:651-259-9790
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14993104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker