Provider Demographics
NPI:1801535158
Name:HEDBERG, EMILY (LADC, LPCC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HEDBERG
Suffix:
Gender:F
Credentials:LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8506
Mailing Address - Country:US
Mailing Address - Phone:612-750-7418
Mailing Address - Fax:
Practice Address - Street 1:6375 W 143RD ST
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2888
Practice Address - Country:US
Practice Address - Phone:612-750-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306505101YA0400X
101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
MNCC04394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional