Provider Demographics
NPI:1003281536
Name:WEGNER, HEATHER LEANN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANN
Last Name:WEGNER
Suffix:
Gender:
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEANN
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10567 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-3523
Mailing Address - Country:US
Mailing Address - Phone:529-767-9374
Mailing Address - Fax:555-380-6638
Practice Address - Street 1:10567 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-3523
Practice Address - Country:US
Practice Address - Phone:527-679-3749
Practice Address - Fax:855-538-0663
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional