Provider Demographics
NPI:1629214747
Name:SVOBODA, HEATHER LYNN (MA LP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:SVOBODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LP
Mailing Address - Street 1:7601 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1623
Mailing Address - Country:US
Mailing Address - Phone:763-521-3477
Mailing Address - Fax:763-521-3893
Practice Address - Street 1:310 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3218
Practice Address - Country:US
Practice Address - Phone:612-223-8898
Practice Address - Fax:612-338-8899
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5110103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist