Provider Demographics
NPI:1790063253
Name:KOSTER, HEATHER DAWN (LICSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:KOSTER
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 1:7975 STONE CREEK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4615
Mailing Address - Country:US
Mailing Address - Phone:952-454-2835
Mailing Address - Fax:
Practice Address - Street 1:7975 STONE CREEK DR STE 110
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4615
Practice Address - Country:US
Practice Address - Phone:952-454-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN159891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical