Provider Demographics
NPI:1881922805
Name:FORSYTH, HEATHER MAE (PSYD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MAE
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:MAE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8455 FLYING CLOUD DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3974
Mailing Address - Country:US
Mailing Address - Phone:952-993-2498
Mailing Address - Fax:
Practice Address - Street 1:8455 FLYING CLOUD DR
Practice Address - Street 2:SUITE 205
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3974
Practice Address - Country:US
Practice Address - Phone:952-993-2498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5389103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical