Provider Demographics
NPI:1295903482
Name:ROSE-CARLSON, HEATHER LYNN (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYNN
Last Name:ROSE-CARLSON
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1707 MILLER TRUNK HWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1880
Mailing Address - Country:US
Mailing Address - Phone:218-729-6480
Mailing Address - Fax:218-729-9238
Practice Address - Street 1:1707 MILLER TRUNK HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1880
Practice Address - Country:US
Practice Address - Phone:218-729-6480
Practice Address - Fax:218-729-9238
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical