Basic Information
| Provider Information | |||||||||
| NPI: | 1710310172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSUAGWU | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | ANN-GAJDA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LPCC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | OSUAGWU | ||||||||
| OtherFirstName: | HEIDI | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | LPCC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1919 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ST. PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667999 | ||||||||
| FaxNumber: | 6512667850 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 UNIVERSITY AVE | ||||||||
| Address2: | SUITE 127-A | ||||||||
| City: | ST. PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551304400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667900 | ||||||||
| FaxNumber: | 6512663522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CC00611 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.