Provider Demographics
NPI:1669599809
Name:RAPPANA, HEATHER LYNN (MSW,LICSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:RAPPANA
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W SUPERIOR ST
Mailing Address - Street 2:#702
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1805
Mailing Address - Country:US
Mailing Address - Phone:218-722-4058
Mailing Address - Fax:218-722-4059
Practice Address - Street 1:314 W SUPERIOR ST
Practice Address - Street 2:#702
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1805
Practice Address - Country:US
Practice Address - Phone:218-722-4058
Practice Address - Fax:218-722-4059
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN158351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN86G20RAOtherBCBS