Provider Demographics
NPI:1790179679
Name:DEVENY-LEGGITT, HEATHER (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:DEVENY-LEGGITT
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 1:6230 10TH ST N STE 310A
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6166
Mailing Address - Country:US
Mailing Address - Phone:952-412-3673
Mailing Address - Fax:
Practice Address - Street 1:6230 10TH ST N STE 310A
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6166
Practice Address - Country:US
Practice Address - Phone:952-412-3673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN218671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical